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Prolactinoma
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
The main potential risk to the fetus is from dopamine agonist treatment of hyperprolactinemia. As dopaminergic neurons form early in fetal development, dopamine represents a key component of motor and cognitive development, and both bromocriptine and cabergoline cross the placenta [7, 15, 16]. Administration of bromocriptine during the first months of pregnancy does not harm the fetus (over 6000 pregnancies reported) [7, 8, 17–19]. Data available about the use of bromocriptine later in pregnancy are less, but no adverse events have been reported. Cabergoline use in pregnancy is probably safe as well (over 1000 pregnancies reported), but less experience is reported in comparison to bromocriptine (see also preconception counseling) [7, 15, 16, 19–23]. Because of the long half-life of cabergoline, concerns were raised about use in pregnancy induction (i.e. achieving pregnancy in a previously infertile woman) [15], however use of cabergoline in early pregnancy has not been associated with negative outcomes and thus far, there is no evidence to suggest an increased risk of major malformations beyond the baseline risk [7, 15, 16, 19, 22, 23]. There are however, limited data available about use of cabergoline throughout pregnancy [5, 7, 15].
Endocrine and Neuroendocrine Tumors
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Natasha Shrikrishnapalasuriyar, P.N. Plowman, Márta Korbonits, Ashley B. Grossman
Treatment involves cabergoline, starting with 0.25 mg once a week and increasing over 2–3 weeks to 0.5 mg once or twice a week. Resistance due to intolerable side-effects may occasionally be responsive to an alternative dopamine agonist such as bromocriptine or quinagolide, but this is a rare occurrence. Most data on safety in inducing conception have been obtained with bromocriptine, with more than 20 years’ evidence of a lack of teratogenicity or problems in pregnancy. To date, cabergoline and quinagolide appear to be equally safe, but the relative long-term experience is more limited. However, many would not switch from cabergoline to bromocriptine for the induction of conception.
Pharmacological Management of Parkinson’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Newman Osafo, Samuel Obeng, David D. Obiri, Oduro K. Yeboah, Leslie B. Essel
Cabergoline is well absorbed when orally administration. The drug undergoes extensive hydrolysis in the liver leading to the breaking of the acylurea bond of the urea moiety and is excreted in the bile and feces. Its extremely long half-life is advantageous, as it alleviates the problem of “off” reactions and a once daily administration is favored (Andreotti et al., 1995).
Does cabergoline administration affect endometrial VEGFR-2 expression in a rat model of ovarian hyperstimulation syndrome?
Published in Gynecological Endocrinology, 2023
Nafiye Yilmaz, Pinar Gulsen Coban, Saynur Yilmaz, Hasan Ali Inal, Hakan Timur, Hacer Haltas
According to the American Society for Reproductive Medicine, there is good evidence that dopamine agonist administration starting at the time of hCG trigger reduces the incidence of OHSS [21]. However, in the majority of important human clinical studies assessing the effect of cabergoline, the reported evidence was not of high quality in terms of implantation rates, pregnancy rates or miscarriage rates. A review study of 858 women undergoing ART postulated that cabergoline was unlikely to affect clinical pregnancy, although the evidence was low-quality (RR 1.02, 95% CI 0.78–1.34, p = 0.86) [22]. In a Cochrane data analysis involving 16 randomized controlled trials, clinical pregnancy rates were comparable between placebo and intervention groups, the evidence being of moderate quality, although that analysis included not only cabergoline but also other two types of dopamine agonist (bromocriptine and quinagolide) (OR 0.81, 95% CI 0.54 to 1.22) [23].
Drug treatment strategies for secondary diabetes in patients with acromegaly
Published in Expert Opinion on Pharmacotherapy, 2020
Sylvère Störmann, Jochen Schopohl
Since their first successful use in patients with acromegaly [134], dopamine agonists have been the only viable option of medical acromegaly treatment until SSA became available. Nowadays, cabergoline is the recommended dopamine agonist in this indication: it normalizes IGF-I levels in approximately one-third of selected patients and can show positive effects on biochemical activity as an adjunct to a not fully effective SSA therapy [135,136]. Early reports demonstrated positive effects of bromocriptine on insulin secretion and glucose tolerance [137–140]. Rau and colleagues showed improvements of glucose homeostasis in patients with acromegaly that were treated with bromocriptine for 12 years on average [141]. In a study by Roemmler et al., serial assessments of GH, glucose, and insulin levels in patients treated with pegvisomant were compared to an investigational single application of cabergoline [142]. When cabergoline was added, there was a less pronounced post-prandial increase of glucose and insulin levels. In a prospective clinical trial with a sequence of cabergoline monotherapy, then combined with pegvisomant and later cabergoline withdrawal no significant changes of glucose homeostasis were found except for an improved response after glucose load during cabergoline monotherapy [143]. Overall, cabergoline exerts a positive, but nominally mild effect on glucose tolerance.
Adrenal disorders in pregnancy, labour and postpartum – an overview
Published in Journal of Obstetrics and Gynaecology, 2020
Madhavi Manoharan, Prabha Sinha, Shabnum Sibtain
Medical treatment with anticortisolic drugs remains a second line of treatment (Lim et al. 2013; Touiti and Mghari 2015; Zieleniewski and Michalak 2017). The drugs commonly used are Metyrapone, Ketoconazole, Cyproheptidine, Amino-glutethemide, Mitotane and Cabergoline. They act by inhibiting steroid synthesis. Metyrapone is the most commonly used treatment with no side effects on maternal liver function or foetal development. This has been used in 69% of cases with good control of hyper cortisolism, in most of the cases (Lindsay et al. 2005; Blanco et al. 2006). However, Metyrapone can exacerbate high blood pressure and preeclampsia. Ketoconazole is not advisable in pregnancy because of risk of transplacental passage and its teratogenic and antiandrogenic effects on the fetus. (Berwaerts et al. 1999; Lindsay et al. 2005; Boronat et al. 2011). Mitotane and aminoglutethimide are also contraindicated during pregnancy because of risk of foetal masculinisation and teratogenicity (McClamrock and Adashi 1992). Cabergoline is not commonly used in pregnancy, unless the condition is persistent and recurrent (Woo and Ehsanipoor 2013; Nakhleh et al. 2016; Sek et al. 2017). Medical treatment with anticortisolic drugs could be reserved for special cases, with Metyrapone being the safest option. These drugs should be used with extreme caution in view of the low number of patients reported and limited experience with its use (Brue et al. 2018).