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Description
How does it work?
Dostinex tablets contain the active ingredient cabergoline,
which is a type of medicine called a dopamine agonist. (NB. Cabergoline is also
available without a brand name, ie as the
generic medicine.) Cabergoline works by mimicking the
activity of a substance in the brain called dopamine.
Cabergoline is mainly used to treat disorders that result from
high levels of the hormone prolactin in the blood. Prolactin is produced by the
pituitary gland in the brain. It is the hormone that stimulates the production
of breast milk.
Cabergoline decreases the production of prolactin from the
pituitary gland by acting on dopamine receptors found on the pituitary gland.
A high prolactin level is associated with several conditions.
Over-production of this hormone can cause abnormal production of breast milk in
both men and women (galactorrhoea). It can also cause womens' menstrual periods
to become irregular or stop altogether, and can stop ovulation, resulting in
infertility. Reducing prolactin levels with cabergoline can therefore treat
these conditions - stopping breast milk production and restoring fertility.
Cabergoline is also sometimes used to prevent or stop milk
production for medical reasons following childbirth, stillbirth or abortion.
A further use of cabergoline is to reduce prolactin production
from a type of tumour of the pituitary gland, called a prolactinoma.
Cabergoline can cause a drop in blood pressure when you first
start treatment, and this may cause dizziness or fainting.
What is it used for?
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Disorders caused by over-production of the hormone prolactin,
such as
irregular or missing menstrual periods, stopping of
ovulation resulting in
infertility, or abnormal production of breast milk in
men or women.
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Benign tumours in the pituitary gland that cause increased
production of the hormone prolactin (prolactinomas).
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Preventing or stopping milk production (lactation) for medical
reasons following childbirth, stillbirth or abortion.
(NB. Cabergoline is also used in higher doses to treat
Parkinson's disease. The Dostinex brand of cabergoline is not licensed for this
use. See the Cabaser factsheet linked at the end of this article for more
information on this other use of cabergoline.)
Warning!
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Dostinex tablets should be taken with or after food to minimise
the chance of experiencing side effects such as nausea or
indigestion.
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This medicine can occasionally cause your blood pressure to
drop when you move from a lying down or sitting position to sitting or
standing, especially when you first start taking the medicine. This may make
you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel
dizzy, sit or lie down until the symptoms pass. Drinking alcohol may increase
the chance of feeling dizzy. It is recommended that your blood pressure is
monitored for the first few days if you are taking this medicine following
childbirth.
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This medicine can cause sleepiness and on rare occasions people
have experienced a sudden onset of sleep during their daily activities. In some
cases this occured without any warning signs. Although this is uncommon, you
should exercise caution when driving or performing other potentially hazardous
activities. People who have experienced sleepiness or an episode of sudden
onset of sleep while taking this medicine should not drive or operate
machinary. Caution should be observed when drinking alcohol or taking other
medicines that cause drowsiness, as this may increase the risk of
drowsiness.
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On rare occasions people taking cabergoline have developed a
fibrous thickening of the lining that covers some of the internal organs
including the kidneys, the heart or the lungs. This is called a fibrotic
reaction. Your doctor may want you to have a chest
X-ray and
blood tests before starting treatment and regularly
during treatment to monitor for this. Consult your doctor if you develop any of
the following symptoms while taking this medicine, so they can be investigated:
shortness of breath, persistent cough, chest pain, swelling of the lower legs,
pain in the lower back, or abdominal pain or tenderness.
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It is recommended that women taking this medicine for long
periods of time should have regular gynaecological exams, including pregnancy
tests and smear tests.
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Dostinex tablets absorb moisture, so you should always replace
the cap after taking your tablets. Do not remove the special dessicant granules
from the cap, and do not transfer your tablets to another container.
Use with caution in
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Severely decreased liver function.
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Disease involving the heart and blood vessels (cardiovascular
disease).
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Narrowing of the blood vessels in the hands, causing numb and
painful fingers (Raynaud's disease).
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Low blood pressure (hypotension).
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Women with
high blood pressure following childbirth.
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Peptic
ulcer.
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Bleeding from the stomach or intestines.
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History of fibrotic disorders affecting the lungs, lower back,
kidneys or heart.
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History of serious mental illness, particularly
psychosis.
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Hereditary blood disorders called porphyrias.
Not to be used in
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Children and adolescents under 16 years of age.
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Allergy to other ergot alkaloid derived medicines, eg
pergolide, bromocriptine, lisuride, ergotamine, ergometrine.
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History of high blood pressure, tissue swelling (eg swollen
ankles, face or hands) and protein in the urine during pregnancy (pre-eclampsia).
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History of
depression or psychosis following childbirth.
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Pregnancy.
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Breastfeeding.
This medicine should not be used if you are allergic to one or
any of its ingredients. Please inform your doctor or pharmacist if you have
previously experienced such an
allergy.
If you feel you have
experienced an allergic reaction, stop using this medicine and inform your
doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or
breastfeeding. However, other medicines may be safely used in pregnancy or
breastfeeding providing the benefits to the mother outweigh the risks to the
unborn baby. Always inform your doctor if you are pregnant or planning a
pregnancy, before using any medicine.
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This medicine should not be used in pregnancy because its
safety has not been fully established. You should use a non-hormonal method of
contraception to prevent pregnancy while you are taking this medicine. If you
get pregnant during treatment you should stop taking this medicine. Women who
want to try for a baby should stop taking this medicine one month beforehand.
Seek further medical advice from your doctor.
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This medicine should not be used by mothers who wish to
breastfeed because it suppresses the production of breast milk. If you are
taking this medicine to suppress milk production and it doesn't work, you
should still not breastfeed, because it is not known if the medicine passes
into breast milk. Seek further medical advice from your doctor.
Label warnings
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Take this medication with or after food.
Side effects
Medicines and their possible side effects can affect individual
people in different ways. The following are some of the side effects that are
known to be associated with this medicine. Because a side effect is stated
here, it does not mean that all people using this medicine will experience that
or any side effect.
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Nausea.
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Sleepiness.
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Headache.
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Dizziness.
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Fainting.
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Breast pain.
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Indigestion (dyspepsia).
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Abdominal pain.
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Constipation.
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Inflammation of the stomach (gastritis).
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Depression.
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Low blood pressure (hypotension).
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Suddenly falling asleep.
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Skin reactions such as rash or itching.
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Fatigue.
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Muscle weakness.
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Hot flushes.
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Pins and needles sensations.
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Leg cramps.
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Palpitations.
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Nosebleeds.
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Temporary partial loss of vision.
The side effects listed above may not include all of the side
effects reported by the drug's
manufacturer.
For more
information about any other possible risks associated with this medicine,
please read the information provided with the medicine or consult your doctor
or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines
you are already taking, including those bought without a prescription and
herbal medicines, before you start treatment with this medicine. Similarly,
check with your doctor or pharmacist before taking any new medicines while
taking this one, to ensure that the
combination is safe.
This medicine is not recommended for use in combination with
other ergot alkaloid derivatives, such as pergolide, bromocriptine, lisuride,
ergotamine, dihydroergotamine, methysergide or ergometrine.
There may be an increased risk of a drop in blood pressure that
makes you feel dizzy if this medicine is taken in combination with other
medicines that can lower blood pressure, for example medicines to treat high
blood pressure (antihypertensives). Tell your doctor if you feel dizzy after
starting treatment with this medicine, as your doctor may need to adjust the
dose of your blood pressure medicine.
This medicine should not normally be taken in combination with
the following medicines, as these work by decreasing the activity of dopamine
in the brain and so may oppose the effect of cabergoline:
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antipsychotic medicines, eg chlorpromazine,
haloperidol
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domperidone
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metoclopramide.
Macrolide-type antibiotics such as erythromycin may possibly
increase the concentration of cabergoline in the blood, which may increase the
risk of its side effects. However, small amounts of erythromycin applied to the
skin can be used safely.
Other medicines containing the same active ingredient
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