Medication Name and Formulation

Dostinex is a brand name for the medication cabergoline. It is primarily available in tablet form. Each tablet contains 0.5 mg of cabergoline.

Indications for Use

Dostinex is prescribed to treat hyperprolactinemia, a condition characterized by high levels of prolactin in the blood. It is also used to manage disorders related to high prolactin levels, such as prolactinoma.

Mechanism of Action

Cabergoline works by stimulating dopamine receptors in the pituitary gland. This action inhibits the secretion of prolactin, thus lowering its levels in the blood. Dopamine agonism also impacts certain neurological pathways, contributing to its therapeutic effects.

Dosage Instructions

For hyperprolactinemia, the initial dose is typically 0.25 mg taken twice a week. The dose can be gradually increased up to a maximum of 1 mg twice a week. Dose adjustments should be based on serum prolactin levels and patient tolerance.

Administration Guidance

Dostinex tablets should be taken orally, with or without food. Swallow the tablet whole with a full glass of water. Do not crush or chew the tablet. Consistency in the timing of doses can help maintain stable drug levels in the body.

Drug Interactions

Cabergoline may interact negatively with antipsychotic medications and drugs that inhibit hepatic enzyme CYP3A4. It is crucial to discuss all medications, including over-the-counter drugs and supplements, with a healthcare provider.

Contraindications

Dostinex should not be used in patients with uncontrolled hypertension, heart valve disorders, or known hypersensitivity to cabergoline or any of its excipients. Avoid use during postpartum period for women with a history of coronary artery disease.

Adverse Effects

Common side effects include nausea, headache, dizziness, and fatigue. Rare but severe effects may include heart valve problems, psychiatric symptoms, and respiratory disorders. Immediate medical attention is necessary for severe reactions.

Monitoring Parameters

Regular monitoring of serum prolactin levels is essential to gauge the effectiveness of the treatment. Periodic cardiac monitoring may be required for patients using Dostinex long-term. Evaluate for signs of fibrosis or valvulopathy.

Special Populations Considerations

For elderly patients, dose adjustments may be necessary due to the risk of organ function decline. In patients with hepatic impairment, there’s a need for careful monitoring and possible dose adjustments. Pregnant or breastfeeding women should use Dostinex only if clearly needed.

Storage Instructions

Store Dostinex at room temperature, away from moisture and heat. Keep the medication out of reach of children and pets. Do not use the medication past the expiration date indicated on the packaging.

Missed Dose Protocol

If a dose is missed, it should be taken as soon as the patient remembers unless it is close to the time for the next dose. Do not double the dose to make up for the missed one; resume the regular dosing schedule.

Overdose Management

Symptoms of overdose may include nausea, vomiting, decreased blood pressure, and confusion. Immediate medical attention is required. Activated charcoal may be used to reduce absorption if the overdose is recent.

Patient Counseling Information

Advise the patient to report any symptoms of heart valve issues such as shortness of breath or swelling of extremities. Educate about the importance of routine blood tests for prolactin levels. Suggest lifestyle modifications that may support treatment efficacy.

Clinical Pharmacokinetics

After oral administration, cabergoline is well-absorbed with peak plasma concentrations reached within 2 to 3 hours. The half-life of cabergoline varies but can extend up to 63-69 hours, allowing for a twice-weekly dosing regimen. Metabolism occurs predominantly in the liver, and excretion is primarily through feces.

Pharmacodynamics Insights

Cabergoline’s effects on prolactin levels are typically dose-dependent, achieving a significant reduction within hours of administration. The dopamine agonist properties also highlight its potential impact on various neurological functions.