PDR MEMBER LOGIN:
  • PDR Search

    Required field
  • Advertisement
  • CLASSES

    Anti-Parkinson drugs, Dopamine Agonists
    Prolactin Inhibitors

    DEA CLASS

    Rx

    DESCRIPTION

    Ergoline-derived dopamine agonist; more effective than bromocriptine in suppressing prolactin secretion; long half-life; twice weekly administration for hyperprolactinemia; beneficial for motor fluctuations of Parkinson's disease or restless-legs syndrome.

    COMMON BRAND NAMES

    Dostinex

    HOW SUPPLIED

    Cabergoline/Dostinex Oral Tab: 0.5mg

    DOSAGE & INDICATIONS

    For the treatment of hyperprolactinemia, either idiopathic or due to a pituitary adenoma.
    Oral dosage
    Adults

    Initially, 0.25 mg PO twice per week; titrate by 0.25 mg/dose no more than every 4 weeks up to 1 mg PO twice per week, if needed. If the patient does not respond adequately and no additional benefit is observed with higher doses, use the lowest cabergoline dose that achieved maximal response and consider other therapeutic approaches. Once weekly administration has also been found effective at dosages of 0.5—3 mg/week. Prolactin levels normalized in 73% of patients, and tumor size decreased by a mean of 31% (range 5—95%). Discontinuation may be considered after 6 months of acceptable serum prolactin levels. Periodic determinations of prolactin should be made to assess the need for re-initiation of cabergoline treatment.

    Vaginal dosage†
    Adult females

    Case reports indicate that 0.5 mg PV 2—5 times per week may be effective in normalizing prolactin levels for those intolerant to orally administered dopamine agonists. The lowest possible dose required to control symptoms should be used.

    For the treatment of motor fluctuations associated with Parkinson's disease†.
    Oral dosage
    Adults

    Optimal dosage not established. Initially 0.5 mg/day PO and titrate to response. The mean effective dose appears to be approximately 3 mg/day PO; dosages range from 0.5—6 mg/day. Similar dosages are effective when cabergoline is used as adjunct therapy to carbidopa/levodopa. Dosages up to 20 mg/day PO have been used; however, further studies are needed before high-dose cabergoline can be recommended.

    For the treatment of restless legs syndrome (RLS)†.
    Oral dosage
    Adults

    Initially, 0.5 mg PO once daily at bedtime. Slowly titrate upward as needed until symptoms resolve or drug intolerance limits further adjustment. Mean effective dosage 2 mg/day PO, but ranged from 1—4 mg/day in studies. Further study is needed.

    †Indicates off-label use

    MAXIMUM DOSAGE

    Adults

    Maximum dosage not well defined; up to 6 mg/day PO has been used in Parkinson's Disease; up to 1 mg PO twice per week for hyperprolactinemia.

    Elderly

    Maximum dosage not well defined; up to 6 mg/day PO has been used in Parkinson's Disease; up to 1 mg PO twice per week for hyperprolactinemia.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    Cabergoline is extensively metabolized in the liver. Although quantitative guidelines are not available, a dosage reduction should be considered in those with significant hepatic impairment.

    Renal Impairment

    Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

    ADMINISTRATION

    Oral Administration

    May be administered without regard to meals.

    STORAGE

    Dostinex:
    - Store at controlled room temperature (between 68 and 77 degrees F)

    CONTRAINDICATIONS / PRECAUTIONS

    Ergot alkaloid hypersensitivity

    Cabergoline is contraindicated in patients with a hypersensitivity to cabergoline or a known ergot alkaloid hypersensitivity because of the possibility of an allergic reaction including anaphylaxis.

    Hepatic disease

    Cabergoline is extensively metabolized in the liver, primarily through hydrolysis. The AUC and peak plasma concentrations of the drug are increased in the presence of severe hepatic impairment. Although quantitative guidelines are not available, a dosage reduction should be considered in those with significant hepatic disease; careful patient monitoring is advised.

    Driving or operating machinery

    Dizziness and drowsiness are frequently reported side effects of cabergoline. Patients should therefore be cautioned about engaging in tasks requiring mental alertness such as driving or operating machinery until they know how the drug will affect their cognition.

    Hypotension

    Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with orthostatic hypotension in some instances. Initiating treatment with dosages greater than 1 mg PO are most likely to produce this effect. Cabergoline should be used cautiously in those with a history of hypotension or those receiving medications known to cause hypotension.

    Hypertension

    Like other ergot derivatives, cabergoline is contraindicated in patients with uncontrolled hypertension. The drug should be discontinued immediately if hypertension, severe headaches, or other adverse CNS signs appear.

    Constrictive pericarditis, pleural effusion, pulmonary fibrosis

    Cabergoline is contraindicated for use by patients with a history of pulmonary, pericardial, cardiac valvular or retroperitoneal fibrotic disorders. Cabergoline should not be used in patients with a history of or current signs/clinical symptoms of respiratory or cardiac disorders linked to fibrotic tissue such as pulmonary fibrosis. One case of constrictive pericarditis with the subsequent development of pleuropulmonary inflammatory-fibrotic syndrome has occurred in conjunction with cabergoline administration. Similar to other ergot derivatives, cabergoline can cause fibrotic changes, inflammatory fibrosis, pleural effusion, and valvulopathy with chronic administration. Therefore, patients receiving cabergoline should be monitored for the potential development of fibrotic disorders. Clinical and diagnostic monitoring (e.g., erythrocyte sedimentation rate, chest x-ray, serum creatinine) should be considered at baseline and as clinically indicated during cabergoline treatment. Potential signs and symptoms of fibrotic disorders including dyspnea, chronic cough, chest pain, renal insufficiency, ureteral/abdominal vascular obstruction, abdominal masses or tenderness, and cardiac failure should be promptly evaluated. According to the manufacturer, discontinuation of cabergoline has resulted in an improvement in the signs and symptoms of pleural effusion and pulmonary fibrosis.

    Valvular heart disease

    Cabergoline is contraindicated in patients with a history of valvular heart disease, as suggested by anatomical evidence of valvulopathy of any valve, determined by pre-treatment evaluation including echocardiographic demonstration of valve leaflet thickening, valve restriction, or mixed valve restriction stenosis. Cautious use of cabergoline is recommended in patients who have been exposed to other medications associated with valvulopathy. All patients should undergo a cardiovascular evaluation, including an echocardiogram, before cabergoline initiation to assess for valvular disease. If valvular disease is present, cabergoline treatment should not be initiated. Clinical and diagnostic monitoring (e.g., chest x-ray, CT scan, cardiac echocardiogram) should be conducted periodically in all patients receiving cabergoline to evaluate the risk of cardiac valvulopathy. The manufacturer recommends echocardiographic monitoring every 6 to 12 months or as clinically indicated by the presence of edema, new cardiac murmur, dyspnea, congestive heart failure, or other signs and symptoms of valvulopathy. Cabergoline should be discontinued if an echocardiogram demonstrates new valvular regurgitation, valvular restriction, or valve leaflet thickening (see Adverse Reactions).

    Dementia, psychosis, schizophrenia

    Dopamine agonists are sometimes used as alternatives to anticholinergics for the treatment of extrapyramidal symptoms (EPS) associated with antipsychotics. However, dopamine agonists can exacerbate the symptoms of schizophrenia such as hallucinations. Cabergoline should be used cautiously in patients with psychosis or psychotic disorders. Cabergoline has also caused hallucinations and confusion in Parkinson's patients receiving the drug. It should therefore be used with extreme caution in parkinsonian patients who exhibit signs of dementia. Hallucinations can occur during cabergoline monotherapy or when the drug is used concomitantly with levodopa.

    Depression

    Depression has been reported in 1—5% of patients receiving cabergoline. Patients with depressive disorders should be closely monitored during treatment with cabergoline.

    Impulse control symptoms

    Some patients receiving medications that increase dopaminergic tone have reported intense and uncontrollable urges to gamble, increased sexual urges, or other intense urges. Causality due to dopaminergic agents has not been established; however, in some cases the urges stopped after the dose was reduced or the drug was discontinued. Practitioners should inquire periodically about new or worsening impulse control symptoms in patients receiving cabergoline. Likewise, patients should be instructed to report such changes while receiving cabergoline. Dose reduction or discontinuation should be considered in those who experience these effects.

    Eclampsia, preeclampsia, pregnancy

    Dopamine agonists, such as cabergoline, should generally not be used in patients with pregnancy-induced hypertension (eclampsia, preeclampsia, and postpartum hypertension). Use of other dopamine agonists (e.g., bromocriptine) has been associated with hypertension, seizures, myocardial infarction, and stroke in postpartum patients. Cabergoline is classified as pregnancy category B. Reproductive studies in rabbits have shown no teratogenic or embryotoxic effects; however, maternal toxicity characterized by a loss of body weight and decreased food consumption has been noted. An increase in post-implantation embryofetal losses has been observed in rat studies. In one review of over 200 pregnancies in cabergoline-exposed women, no increases in miscarriage rates or congenital malformations, abnormal distribution of birthweights, or disturbances in postnatal development were noted in comparison to the expected rate in the general population. The range of embryo-fetal exposure to cabergoline was between 1 and 144 days. Among 56 women receiving cabergoline for amenorrhea secondary to hyperprolactinemia, the following outcomes were reported in 17 subsequent pregnancies: 1 spontaneous abortion, 6 pending outcomes, and 10 term infants with normal physical and mental development. In a separate group of women receiving cabergoline for hyperprolactinemia, the following outcomes were reported in 61 pregnancies: 5 elective abortions (1 suspected malformation), 6 spontaneous abortions, 1 hydatidiform mole, and 49 live births (1 minor defect and 1 trisomy). In one study enrolling 47 hyperprolactinemic females, 9 became pregnant against medical advice. Treatment with cabergoline was interrupted when pregnancy was diagnosed. The pregnancy outcomes included 1 voluntary termination, 1 spontaneous termination, and 7 healthy term infants showing normal development during 8 years of continuing follow-up. One case describes a patient who became pregnant on two separate occasions while receiving L-dopa and cabergoline for Parkinson's disease. The medications were continued throughout the pregnancies. There were no fetal complications; however, C-section was required in the second birth due to placental abruption. Although the available data suggest a low fetal risk in early pregnancy, the risk to the developing fetus during chronic cabergoline exposure is unknown. Therefore, cabergoline should be used during pregnancy only if clearly needed. Because cabergoline therapy can result in reversal of prolactin-induced infertility, patients of childbearing potential should be instructed to use suitable birth control methods during treatment and to notify their physician if they suspect they are pregnant, become pregnant, or intend to become pregnant during therapy. Conduct a pregnancy test if there is any suspicion of pregnancy. The effects of cabergoline in labor and delivery are unknown.

    Breast-feeding

    According to the manufacturer, cabergoline should not be used in women who are breast-feeding or plan to breast-feed because cabergoline interferes with lactation as a result of central inhibition of prolactin secretion. Cabergoline is also not indicated for postpartum lactation inhibition because the use of other dopamine agonists (e.g., bromocriptine) for this purpose has resulted in hypertension, stroke, and seizures. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

    Children

    The safety and efficacy of cabergoline in pediatric patients, particularly children, have not been established. The drug has been used off-label in the treatment of select adolescent patients with hyperprolactinemia with etiologic factors such as adenoma. However, no formal controlled trials are available.

    Geriatric

    Clinical studies of cabergoline did not include a sufficient number of patients 65 years and older to determine whether they respond differently than younger adults. Other reported clinical experience has not identified differences in responses between geriatric and younger adult patients. In general, cabergoline dosing should be more cautious in geriatric patients, starting at the lower end of the dose range to account for differences in renal, hepatic, or cardiac systems as well as concomitant disease states and medications. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities (LTCFs). According to OBRA, antiparkinson medications may cause significant confusion, restlessness, delirium, dyskinesia, nausea, dizziness, hallucinations, and agitation. In addition, there is an increased risk of postural hypotension and falls, particularly during concurrent use of antihypertensive agents.

    ADVERSE REACTIONS

    Severe

    visual impairment / Early / 0-1.0
    peptic ulcer / Delayed / Incidence not known
    heart failure / Delayed / Incidence not known
    pulmonary fibrosis / Delayed / Incidence not known
    pericarditis / Delayed / Incidence not known
    retroperitoneal fibrosis / Delayed / Incidence not known
    pleural effusion / Delayed / Incidence not known
    cardiac valvulopathy / Delayed / Incidence not known

    Moderate

    constipation / Delayed / 7.0-10.0
    orthostatic hypotension / Delayed / 4.0-4.0
    hot flashes / Early / 1.0-3.0
    depression / Delayed / 3.0-3.0
    edema / Delayed / 0-1.0
    hypotension / Rapid / 0-1.0
    palpitations / Early / 1.0-1.0
    peripheral edema / Delayed / 1.0-1.0
    impulse control symptoms / Delayed / Incidence not known
    psychosis / Early / Incidence not known
    dyskinesia / Delayed / Incidence not known
    confusion / Early / Incidence not known
    hallucinations / Early / Incidence not known

    Mild

    nausea / Early / 27.0-29.0
    headache / Early / 26.0-26.0
    dizziness / Early / 15.0-17.0
    asthenia / Delayed / 6.0-9.0
    fatigue / Early / 5.0-7.0
    abdominal pain / Early / 5.0-5.0
    dyspepsia / Early / 2.0-5.0
    drowsiness / Early / 0-5.0
    vomiting / Early / 2.0-4.0
    vertigo / Early / 1.0-4.0
    diarrhea / Early / 0-2.0
    flatulence / Early / 0-2.0
    xerostomia / Early / 0-2.0
    paresthesias / Delayed / 0-2.0
    mastalgia / Delayed / 1.0-2.0
    musculoskeletal pain / Early / 2.0-2.0
    weight gain / Delayed / 0-1.0
    anorexia / Delayed / 0-1.0
    throat irritation / Early / 1.0-1.0
    dental pain / Delayed / 1.0-1.0
    weight loss / Delayed / 0-1.0
    insomnia / Early / 0-1.0
    dysmenorrhea / Delayed / 0-1.0
    malaise / Early / 0-1.0
    syncope / Early / 0-1.0
    anxiety / Delayed / 0-1.0
    acne vulgaris / Delayed / 0-1.0
    pruritus / Rapid / 0-1.0
    arthralgia / Delayed / 1.0-1.0
    epistaxis / Delayed / 0-1.0
    rhinitis / Early / 1.0-1.0
    nasal congestion / Early / 0-1.0
    cough / Delayed / Incidence not known
    libido increase / Delayed / Incidence not known
    alopecia / Delayed / Incidence not known

    DRUG INTERACTIONS

    Acebutolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Dextromethorphan; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Dextromethorphan; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Guaifenesin; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acetaminophen; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Acrivastine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Aliskiren: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Aliskiren; Amlodipine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Aliskiren; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Aliskiren; Valsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Alpha-blockers: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Amiloride: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amiloride; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amitriptyline: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Amitriptyline; Chlordiazepoxide: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Amlodipine; Benazepril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amlodipine; Olmesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amlodipine; Telmisartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amlodipine; Valsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Amphetamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as amphetamines. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Amphetamine; Dextroamphetamine Salts: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as amphetamines. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Amphetamine; Dextroamphetamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as amphetamines. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Angiotensin II receptor antagonists: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Angiotensin-converting enzyme inhibitors: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Articaine; Epinephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as epinephrine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Asenapine: (Major) Asenapine is a central dopamine antagonist and may inhibit the clinical response to antiparkinsonian agents with dopamine agonist properties such as cabergoline by blocking dopamine receptors in the brain. In general, atypical antipsychotics like asenapine are less likely to interfere with these therapies than traditional antipsychotic agents. However, asenapine should be avoided in patients requiring medication for Parkinson's disease unless the benefit of asenapine therapy outweighs the risk of decreased therapeutic response to levodopa or other treatments.
    Atenolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Atenolol; Chlorthalidone: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Theoretically, concurrent use of methylene blue and cabergoline, an ergot derivative, may increase the risk of serotonin syndrome. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and ergot alkaloids increase central serotonin effects. Cases of serotonin syndrome have been reported, primarily following administration of standard infusions of methylene blue (1 to 8 mg/kg) as a visualizing agent in parathyroid surgery, in patients receiving selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or clomipramine. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death.
    Azilsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Azilsartan; Chlorthalidone: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Belladonna Alkaloids; Ergotamine; Phenobarbital: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Benazepril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Benazepril; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Bendroflumethiazide; Nadolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate: (Moderate) Theoretically, concurrent use of methylene blue and cabergoline, an ergot derivative, may increase the risk of serotonin syndrome. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and ergot alkaloids increase central serotonin effects. Cases of serotonin syndrome have been reported, primarily following administration of standard infusions of methylene blue (1 to 8 mg/kg) as a visualizing agent in parathyroid surgery, in patients receiving selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or clomipramine. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death.
    Benzphetamine: (Minor) Additive toxicity may occur if cabergloine and benzphetamine are co-administered. Concurrent use may increase risk of vasoconstriction or spasm, hypertension, ventricular tachycardia, seizures, or sudden loss of vision. Further, cardiac valvulopathy has occurred during treatment with cabergoline; therefore, cabergoline should be used cautiously in patients exposed to other medications associated with valvulopathy. Valvular heart disease has been associated with the use of some anorectic agents. Although no cases of this valvulopathy have been reported when benzphetamine has been used alone, the possiblity of an interaction during concurrent use of cabergoline cannot be ruled out.
    Beta-blockers: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Betaxolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Bisoprolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Bisoprolol; Hydrochlorothiazide, HCTZ: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Brimonidine; Timolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Brompheniramine; Carbetapentane; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Brompheniramine; Hydrocodone; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Brompheniramine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Bumetanide: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Caffeine; Ergotamine: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Candesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Candesartan; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Captopril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Captopril; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Carbetapentane; Chlorpheniramine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbetapentane; Diphenhydramine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbetapentane; Guaifenesin; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbetapentane; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbetapentane; Phenylephrine; Pyrilamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbetapentane; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbidopa; Levodopa: (Minor) Cabergoline and levodopa both increase dopaminergic function centrally. Cabergoline is used as an adjunct to levodopa/carbidopa therapy in patients with Parkinson's disease experiencing motor fluctuations. Although this combination appears safe and effective overall, additive neurologic effects are possible. Hallucinations have been reported with the concurrent use of cabergoline and levodopa.
    Carbidopa; Levodopa; Entacapone: (Minor) Cabergoline and levodopa both increase dopaminergic function centrally. Cabergoline is used as an adjunct to levodopa/carbidopa therapy in patients with Parkinson's disease experiencing motor fluctuations. Although this combination appears safe and effective overall, additive neurologic effects are possible. Hallucinations have been reported with the concurrent use of cabergoline and levodopa.
    Carbinoxamine; Dextromethorphan; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbinoxamine; Hydrocodone; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbinoxamine; Hydrocodone; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbinoxamine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carbinoxamine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Carteolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Carvedilol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Cetirizine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlophedianol; Guaifenesin; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorothiazide: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Chlorpheniramine; Dextromethorphan; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Hydrocodone; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Hydrocodone; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpheniramine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Chlorpromazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Chlorthalidone: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Chlorthalidone; Clonidine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Citalopram: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Clomipramine: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Clozapine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as the antipsychotic drugs. In addition, cabergoline is a dopamine agonist and may diminish the effectiveness of dopamine antagonists such as the antipsychotics.
    Codeine; Phenylephrine; Promethazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics (e.g., prochlorperazine, promethazine, and thiethylperazine). (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Codeine; Promethazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics (e.g., prochlorperazine, promethazine, and thiethylperazine).
    Desipramine: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Desloratadine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Desvenlafaxine: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties, such as cabergoline. Cabergoline has minimal affinity for serotonin receptors, possibly reducing the risk of this interaction compared to the chemically related ergot alkaloids. However, patients receiving cabergoline with an SNRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dextroamphetamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as amphetamines. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dextromethorphan; Diphenhydramine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dextromethorphan; Guaifenesin; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dextromethorphan; Guaifenesin; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dextromethorphan; Promethazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics (e.g., prochlorperazine, promethazine, and thiethylperazine).
    Diethylpropion: (Major) Cardiac valvulopathy has occurred during treatment with cabergoline; therefore, cabergoline should be used cautiously in patients exposed to other medications associated with valvulopathy such as diethylpropion.
    Dihydrocodeine; Guaifenesin; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dihydroergotamine: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Diltiazem: (Major) Diltiazem is an inhibitor of the CYP3A4 isoenzyme. Co-administration with diltiazem may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as cabergoline.
    Diphenhydramine; Hydrocodone; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Diphenhydramine; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dopamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., dopamine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Dorzolamide; Timolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Doxazosin: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Doxepin: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Duloxetine: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties, such as cabergoline. Cabergoline has minimal affinity for serotonin receptors, possibly reducing the risk of this interaction compared to the chemically related ergot alkaloids. However, patients receiving cabergoline with an SNRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Enalapril, Enalaprilat: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Enalapril; Felodipine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Enalapril; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Ephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Epinephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as epinephrine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Eprosartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Eprosartan; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Ergoloid Mesylates: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Ergonovine: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Ergot alkaloids: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Ergotamine: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Escitalopram: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Esmolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Ethacrynic Acid: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Fexofenadine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Fluoxetine: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Fluoxetine; Olanzapine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as olanzapine. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics. (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Fluphenazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Fluvoxamine: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Fosinopril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Fosinopril; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Furosemide: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Guaifenesin; Hydrocodone; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Guaifenesin; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Guaifenesin; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Haloperidol: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as the antipsychotic drugs. In addition, cabergoline, which is a dopamine agonist, may diminish the effectiveness of dopamine antagonists such as the antipsychotics.
    Hydralazine; Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Irbesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Lisinopril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Losartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Methyldopa: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents. (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as methyldopa. Also, cabergoline has been associated with hypotension which may be additive if given with methyldopa.
    Hydrochlorothiazide, HCTZ; Metoprolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Moexipril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Olmesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Propranolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Quinapril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Spironolactone: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Telmisartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Triamterene: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrochlorothiazide, HCTZ; Valsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Hydrocodone; Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Hydrocodone; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate: (Moderate) Theoretically, concurrent use of methylene blue and cabergoline, an ergot derivative, may increase the risk of serotonin syndrome. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and ergot alkaloids increase central serotonin effects. Cases of serotonin syndrome have been reported, primarily following administration of standard infusions of methylene blue (1 to 8 mg/kg) as a visualizing agent in parathyroid surgery, in patients receiving selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or clomipramine. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death.
    Ibuprofen; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Iloperidone: (Major) Iloperidone is a central dopamine antagonist and may inhibit the clinical response to antiparkinsonian agents with dopamine agonist properties such as cabergoline by blocking dopamine receptors in the brain. In general, atypical antipsychotics like iloperidone are less likely to interfere with these therapies than traditional antipsychotic agents. However, iloperidone should be avoided in patients requiring medication for Parkinson's disease unless the benefit of iloperidone therapy outweighs the risk of decreased therapeutic response to levodopa or other treatments.
    Imipramine: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Irbesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Isoproterenol: (Severe) The concomitant administration of ergot alkaloids and sympathomimetics has resulted in dangerous hypertension. Such combinations should be used cautiously.
    Itraconazole: (Moderate) Monitor patients for adverse reactions related to cabergoline if concurrent use of itraconazole is necessary. Cabergoline is a CYP3A4 substrate. In theory, inhibitors of this isoenzyme, such as itraconazole, may decrease the metabolism of cabergoline.
    Labetalol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Levobetaxolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Levobunolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Levodopa: (Minor) Cabergoline and levodopa both increase dopaminergic function centrally. Cabergoline is used as an adjunct to levodopa/carbidopa therapy in patients with Parkinson's disease experiencing motor fluctuations. Although this combination appears safe and effective overall, additive neurologic effects are possible. Hallucinations have been reported with the concurrent use of cabergoline and levodopa.
    Levomilnacipran: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties, such as cabergoline. Cabergoline has minimal affinity for serotonin receptors, possibly reducing the risk of this interaction compared to the chemically related ergot alkaloids. However, patients receiving cabergoline with an SNRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Linezolid: (Moderate) Serious CNS reactions, such as serotonin syndrome, have been reported during the concurrent use of linezolid and psychiatric medications that enhance central serotonergic activity; therefore, caution is warranted with concomitant use of other agents with serotonergic activity, including ergot alkaloids.
    Lisdexamfetamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as amphetamines. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Lisinopril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Loop diuretics: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Loratadine; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Lorcaserin: (Major) Lorcaserin should not be used in combination with serotonergic and dopaminergic drugs that are potent 5-HT2B receptor agonists and are known to increase the risk for cardiac valvulopathy (e.g., cabergoline, ergotamine, dihydroergotamine, and other ergot alkaloids).
    Losartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Loxapine: (Major) Loxapine, a dopamine receptor antagonist, is a pharmacologic antagonist to drugs such as cabergoline, which is a dopamine agonist.
    Lurasidone: (Major) In general, antipsychotics can worsen the motor symptoms of Parkinson's disease thereby decreasing the overall effectiveness of antiparkinsonian agents. In addition, Parkinson's treatments like pramipexole, ropinirole, or tolcapone may cause drowsiness which can result in additive CNS effects with lurasidone. Therefore, lurasidone should be avoided in patients receiving medications for Parkinson's disease unless the benefit of lurasidone therapy outweighs the risk of decreased therapeutic response to levodopa or other treatments.
    Mecasermin rinfabate: (Major) Cardiac valvulopathy has occurred during treatment with cabergoline; therefore, cabergoline should be used cautiously in patients exposed to other medications associated with valvulopathy. Echocardiographic evidence of cardiac valvulopathy has been observed in a few individuals receiving mecasermin, recombinant, rh-IGF-1 therapy. Because of the underlying disease state of the patients and the lack of a control group, the relationship of the valvular changes to drug treatment could not be confirmed; however, the possibility of an interaction during concurrent use of cabergoline cannot be ruled out.
    Mecasermin, Recombinant, rh-IGF-1: (Major) Cardiac valvulopathy has occurred during treatment with cabergoline; therefore, cabergoline should be used cautiously in patients exposed to other medications associated with valvulopathy. Echocardiographic evidence of cardiac valvulopathy has been observed in a few individuals receiving mecasermin, recombinant, rh-IGF-1 therapy. Because of the underlying disease state of the patients and the lack of a control group, the relationship of the valvular changes to drug treatment could not be confirmed; however, the possibility of an interaction during concurrent use of cabergoline cannot be ruled out.
    Meperidine; Promethazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics (e.g., prochlorperazine, promethazine, and thiethylperazine).
    Mepivacaine: (Minor) Avoid the combination of epinephrine and mepivacaine if possible in patients receiving the ergot derivatives, such as cabergoline, due to severe reactions (severe, persistent hypertension or CVA) that can occur between some sympathomimetics such as epinephrine with ergot alkaloids.
    Mepivacaine; Levonordefrin: (Minor) Avoid the combination of epinephrine and mepivacaine if possible in patients receiving the ergot derivatives, such as cabergoline, due to severe reactions (severe, persistent hypertension or CVA) that can occur between some sympathomimetics such as epinephrine with ergot alkaloids.
    Mesoridazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Methamphetamine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as amphetamines. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine: (Moderate) Theoretically, concurrent use of methylene blue and cabergoline, an ergot derivative, may increase the risk of serotonin syndrome. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and ergot alkaloids increase central serotonin effects. Cases of serotonin syndrome have been reported, primarily following administration of standard infusions of methylene blue (1 to 8 mg/kg) as a visualizing agent in parathyroid surgery, in patients receiving selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or clomipramine. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death.
    Methyclothiazide: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Methyldopa: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as methyldopa. Also, cabergoline has been associated with hypotension which may be additive if given with methyldopa.
    Methylene Blue: (Moderate) Theoretically, concurrent use of methylene blue and cabergoline, an ergot derivative, may increase the risk of serotonin syndrome. Methylene blue is a thiazine dye that is also a potent, reversible inhibitor of the enzyme responsible for the catabolism of serotonin in the brain (MAO-A) and ergot alkaloids increase central serotonin effects. Cases of serotonin syndrome have been reported, primarily following administration of standard infusions of methylene blue (1 to 8 mg/kg) as a visualizing agent in parathyroid surgery, in patients receiving selective serotonin reuptake inhibitors, serotonin/norepinephrine reuptake inhibitors, or clomipramine. It is not known if patients receiving other serotonergic psychiatric agents with intravenous methylene blue are at a comparable risk or if methylene blue administered by other routes (e.g., orally, local injection) or in doses less than 1 mg/kg IV can produce a similar outcome. Published interaction reports between intravenously administered methylene blue and serotonergic psychiatric agents have documented symptoms including lethargy, confusion, delirium, agitation, aggression, obtundation, myoclonus, expressive aphasia, hypertonia, pyrexia, elevated blood pressure, seizures, and/or coma. Serotonin syndrome is characterized by rapid development of various symptoms such as hyperthermia, hypertension, myoclonus, rigidity, hyperhidrosis, incoordination, diarrhea, mental status changes (e.g., confusion, delirium, or coma), and in rare cases, death.
    Methylergonovine: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Methysergide: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Metoclopramide: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as metoclopramide.
    Metolazone: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Metoprolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Midodrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Milnacipran: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties, such as cabergoline. Cabergoline has minimal affinity for serotonin receptors, possibly reducing the risk of this interaction compared to the chemically related ergot alkaloids. However, patients receiving cabergoline with an SNRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Moexipril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Molindone: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as molindone. In general, antipsychotics can worsen the motor symptoms of Parkinson's disease thereby decreasing the overall effectiveness of antiparkinsonian agents. Molindone should be avoided in patients receiving medications for Parkinson's disease unless the benefit of molindone therapy outweighs the risk of decreased therapeutic response to levodopa or other treatments.
    Nadolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Naproxen; Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Nebivolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Nebivolol; Valsartan: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Nicardipine: (Major) Nicardipine is an inhibitor of CYP3A4 isoenzymes. Coadministration with nicardipine may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as cabergoline. Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Nicotine: (Minor) In theory, concurrent use of vasoconstrictors, such as nicotine, with cabergoline may result in enhanced vasoconstriction. Nicotine acts indirectly as a sympathomimetic agent by releasing catecholamines, potentially resulting in effects such as hypertension, which may be additive with ergot derivatives such as cabergoline. Use of the ergot derivative bromocriptine with some sympathomimetics has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm. Caution is advisable during use of tobacco or other nicotine-containing products while taking cabergoline.
    Nitroglycerin: (Moderate) Avoid the concomitant use of cabergoline and nitroglycerin. Cabergoline may produce hypotension, but is contraindicated in patients with uncontrolled hypertension and in patients with a history of pericardial or cardiac valvular disease, which are patient populations for which nitroglycerin is utilized.
    Nitroprusside: (Moderate) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Norepinephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Nortriptyline: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Olanzapine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as olanzapine. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics.
    Olmesartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Paliperidone: (Major) Paliperidone is a central dopamine antagonist and may inhibit the clinical antiparkinsonian response of drugs with dopamine agonist properties such as cabergoline by blocking dopamine receptors in the brain. In general, atypical antipsychotics like paliperidone are less likely to interfere with these therapies than traditional antipsychotic agents. However, paliperidone should be avoided in patients requiring medication for Parkinson's disease unless the benefit of paliperidone therapy outweighs the risk of decreased therapeutic response to levodopa or other treatments.
    Paroxetine: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Penbutolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Pergolide: (Major) Although cabergoline is an ergot alkaloid derivative, no evidence of changes in efficacy or safety of cabergoline have been noted when given concomitantly with ergot alkaloids; however, it is prudent to avoid concurrent use to minimize the potential risk of ergot toxicity, cardiac valvulopathy, or extracardiac fibrotic complications.
    Perindopril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Perindopril; Amlodipine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Perphenazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Perphenazine; Amitriptyline: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines. (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Phendimetrazine: (Major) Cardiac valvulopathy has occurred during treatment with cabergoline; therefore, cabergoline should be used cautiously in patients exposed to other medications associated with valvulopathy. Valvular heart disease has been associated with the use of some anorectic agents. Although no cases of this valvulopathy have been reported when phendimetrazine tartrate has been used alone, the possiblity of an interaction during concurrent use of cabergoline cannot be ruled out.
    Phenothiazines: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Phenoxybenzamine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Phentermine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Phentermine; Topiramate: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Phentolamine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Phenylephrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Phenylephrine; Promethazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics (e.g., prochlorperazine, promethazine, and thiethylperazine). (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g. phenylephrine). Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Pimozide: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as pimozide. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics.
    Pindolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Potassium-sparing diuretics: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Prazosin: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Prilocaine: (Minor) Avoid the combination of epinephrine and prilocaine if possible in patients receiving the ergot derivatives, such as cabergoline, due to severe reactions (severe, persistent hypertension or CVA) that can occur between some sympathomimetics such as epinephrine with ergot alkaloids.
    Prilocaine; Epinephrine: (Minor) Avoid the combination of epinephrine and prilocaine if possible in patients receiving the ergot derivatives, such as cabergoline, due to severe reactions (severe, persistent hypertension or CVA) that can occur between some sympathomimetics such as epinephrine with ergot alkaloids. (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as epinephrine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Procaine: (Minor) Avoid the combination of epinephrine and procaine if possible in patients receiving the ergot derivatives, such as cabergoline, due to severe reactions (severe, persistent hypertension or CVA) that can occur between some sympathomimetics such as epinephrine with ergot alkaloids.
    Prochlorperazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Promethazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the antipsychotics and the phenothiazine-type antiemetics (e.g., prochlorperazine, promethazine, and thiethylperazine).
    Propranolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Protriptyline: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Pseudoephedrine: (Minor) In theory, an interaction is possible between cabergoline, an ergot derivative, and some sympathomimetic agents such as vasopressors (e.g., norepinephrine, dopamine, phenylephrine), cocaine, epinephrine, phenylpropanolamine, ephedra, ma huang, pseudoephedrine, amphetamines, and phentermine. Use of the ergot derivative bromocriptine for lactation suppression in conjunction with a sympathomimetic (i.e., isometheptene or phenylpropanolamine) for other therapeutic uses has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm.
    Quetiapine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as the antipsychotic drugs. In addition, cabergoline is a dopamine agonist and may diminish the effectiveness of dopamine antagonists such as the antipsychotics.
    Quinapril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Ramipril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Reserpine: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension including reserpine.
    Risperidone: (Major) Risperidone may inhibit the clinical antiparkinsonian response to cabergoline therapy by blocking dopamine receptors in the brain. In general, atypical antipsychotics like risperidone are less likely to interfere with cabergoline than traditional antipsychotic agents. However, risperidone should be avoided in patients requiring medication for Parkinson's disease unless the benefit of risperidone therapy outweighs the risk of decreased therapeutic response to cabergoline.
    Sacubitril; Valsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Selective serotonin reuptake inhibitors: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Serotonin norepinephrine reuptake inhibitors: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties, such as cabergoline. Cabergoline has minimal affinity for serotonin receptors, possibly reducing the risk of this interaction compared to the chemically related ergot alkaloids. However, patients receiving cabergoline with an SNRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Sertraline: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering selective serotonin reuptake inhibitors (SSRIs) with other drugs that have serotonergic properties such as cabergoline. Patients receiving cabergoline with an SSRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Sotalol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Spironolactone: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Telmisartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Terazosin: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents or other medications known to cause hypotension.
    Tetracaine: (Minor) Avoid the combination of epinephrine and tetracaine if possible in patients receiving the ergot derivatives, such as cabergoline, due to severe reactions (severe, persistent hypertension or CVA) that can occur between some sympathomimetics such as epinephrine with ergot alkaloids.
    Thiazide diuretics: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Thiethylperazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Thioridazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Thiothixene: (Major) Due to antagonistic mechanisms of action, thiothixene may limit the ability of cabergoline to lower serum prolactin concentrations. The combination should be avoided where possible. However, cabergoline does not appear to interfere with the antipsychotic effects of thiothixene if it is added to a stable neuroleptic regimen.
    Timolol: (Major) Because of its potential to cause coronary vasospasm, ergot alkaloids could theoretically antagonize the therapeutic effects of beta-blockers.
    Tobacco: (Minor) In theory, concurrent use of vasoconstrictors, such as nicotine, with cabergoline may result in enhanced vasoconstriction. Nicotine acts indirectly as a sympathomimetic agent by releasing catecholamines, potentially resulting in effects such as hypertension, which may be additive with ergot derivatives such as cabergoline. Use of the ergot derivative bromocriptine with some sympathomimetics has resulted in adverse effects such as worsening headache, hypertension, ventricular tachycardia, seizures, sudden loss of vision, and cerebral vasospasm. Caution is advisable during use of tobacco or other nicotine-containing products while taking cabergoline.
    Torsemide: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Trandolapril: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Trandolapril; Verapamil: (Major) Cabergoline has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents. Also, Verapamil is an inhibitor of CYP3A4 isoenzymes and may decrease the metabolism of ergot alkaloids. (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Triamterene: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Tricyclic antidepressants: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Trifluoperazine: (Major) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as phenothiazines. In addition, cabergoline, a dopamine agonist, can diminish the effectiveness of dopamine antagonists such as the phenothiazines.
    Trimipramine: (Minor) The prolactin-lowering effect of cabergoline may be antagonized by medications that increase prolactin levels such as tricyclic antidepressants.
    Valsartan: (Minor) Cabergoline has minimal affinity for adrenergic receptors; however, it has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents.
    Venlafaxine: (Moderate) Because of the potential risk and severity of serotonin syndrome or neuroleptic malignant syndrome-like reactions, caution should be observed when administering serotonin norepinephrine reuptake inhibitors (SNRIs) with other drugs that have serotonergic properties, such as cabergoline. Cabergoline has minimal affinity for serotonin receptors, possibly reducing the risk of this interaction compared to the chemically related ergot alkaloids. However, patients receiving cabergoline with an SNRI should be monitored for the emergence of serotonin syndrome or neuroleptic malignant syndrome-like reactions.
    Verapamil: (Major) Cabergoline has been associated with hypotension in some instances. Cabergoline should be used cautiously in those receiving antihypertensive agents. Also, Verapamil is an inhibitor of CYP3A4 isoenzymes and may decrease the metabolism of ergot alkaloids.
    Zileuton: (Major) Cabergoline is a cytochrome P450 3A4 substrate. In theory, inhibitors of this isoenzyme, such as zileuton, may decrease the metabolism of cabergoline.
    Ziprasidone: (Major) The prolactin-lowering effect of cabergoline may be antagonized by antipsychotic medications that increase prolactin levels. In addition, cabergoline, which is a dopamine agonist, may diminish the effectiveness of dopamine antagonists such as the antipsychotics. In general, however, atypical antipsychotics like ziprasidone are less likely to interfere with these therapies than traditional antipsychotic agents.

    PREGNANCY AND LACTATION

    Pregnancy

    According to the manufacturer, cabergoline should not be used in women who are breast-feeding or plan to breast-feed because cabergoline interferes with lactation as a result of central inhibition of prolactin secretion. Cabergoline is also not indicated for postpartum lactation inhibition because the use of other dopamine agonists (e.g., bromocriptine) for this purpose has resulted in hypertension, stroke, and seizures. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

    MECHANISM OF ACTION

    Cabergoline is a centrally-acting synthetic ergot alkaloid. Cabergoline causes a dose-dependent suppression of prolactin levels via dopamine agonist activity at dopamine-2 (D2) receptors in the anterior pituitary. Stimulation of D2 receptors in this region of the brain inhibits prolactin secretion by lactotrophs. Cabergoline is seven times more selective for D2 receptors than bromocriptine. The relative D2-selectivity of cabergoline may account for its favorable tolerability profile compared to other dopamine agonists such as bromocriptine. There is minimal affinity for adrenergic, serotonin, or histamine receptors. Cabergoline has little or no effect on the secretion of pituitary hormones such as cortisol, GH, FSH, LH, ACTH, or TSH. Symptoms which may be corrected by the normalization of prolactin levels include loss of libido, amenorrhea, infertility, galactorrhea, gynecomastia, and impotence.

    PHARMACOKINETICS

    Cabergoline is administered orally. Cabergoline is extensively distributed throughout the body and is 40—42% bound to plasma proteins in a concentration-independent manner. A considerable amount of the drug may be found in the pituitary as compared with the plasma. A significant fraction of the administered dose undergoes a first-pass effect. Cabergoline is extensively metabolized by hydrolysis in the liver, with minimal hepatic cytochrome P450 microsomal enzyme involvement. Hydrolysis of the acylurea or urea moiety abolishes the prolactin-lowering effect of cabergoline. At least 4 metabolites are produced; however, none appear to contribute to the primary effect of the drug. The average elimination half-life is 63—69 hours. Cabergoline and its metabolites are eliminated primarily in the feces. After the administration of radioactive cabergoline to five healthy volunteers, approximately 60% of the dose was excreted in the feces, and approximately 22% of the dose was excreted in the urine within 20 days. Less than 4% of the dose was excreted unchanged in the urine.

    Oral Route

    After oral administration, peak plasma concentrations occur in 1—3 hours. The absolute bioavailability of cabergoline is unknown, and the rate and extent of absorption are not affected by food. A significant fraction of the administered dose undergoes a first-pass effect. After a once-weekly dosing schedule, steady-state concentrations are expected to be 2- to 3-fold higher than after a single dose.
     
    After oral administration, higher doses produce prolactin suppression in a greater proportion of patients. Also, higher doses are associated with an earlier onset and longer duration of action in regard to prolactin inhibition. In 12 healthy volunteers, complete prolactin inhibition was obtained in 50% after a 0.5 mg dose, in 92% after a 1 mg dose, and in 100% after a 1.5 mg dose. Single or multiple doses up to 2 mg in healthy patients had no apparent effect on other anterior pituitary hormones such as growth hormone, follicle stimulating hormone, luteinizing hormone, thyroid stimulating hormone, adrenocorticotropin hormone, or cortisol. Among 51 hyperprolactinemic patients who received a single 0.6 mg dose, the duration of effect was 14 days, and the time to maximal effect was 48 hours. In contrast, after a single bromocriptine 2.5 mg dose, the duration of effect was 24 hours, and the time to maximal effect was 6 hours. The prolonged prolactin-lowering effect of cabergoline may be related to its slow elimination and long half-life. Although the duration of effect and time to maximal effect were different, the maximal prolactin decrease was similar after cabergoline or bromocriptine receipt.