Cabergoline

Additional information

Cabergoline is used as second line treatment in patients with Parkinson’s disease, in hyperprolactinomas, and to inhibit lactation and stop hyperlactation [2,3].The reported incidence and prevalence of Parkinson’s disease (PD) is slightly higher in men than in women. It seems that men develop PD earlier in life compared to women. Several possible explanations behind these sex differences have been suggested; the protective role of estrogens in premenopausal women, and different profiles of risk factors (environmental and/or genetic). Sex differences in clinical presentations of PD have also been reported. Since the activities of daily living might differ between men and women with PD, different treatment strategies can be recommended to men and women with PD [1].

Pharmacokinetics and dosing

Cabergoline administrated as single- and multiple-dose in healthy young and elderly individuals showed that young men had 25% higher Cmax than young women, while elderly men had 39% lower Cmax than elderly women. The study-authors suggested these differences were not of clinical relevance [4].

Effects

No published studies analyzing sex differences in the effect of cabergoline in treatment of Parkinson’s diseasehave been found.

Sex differences in the response to cabergoline in treatment of hyperprolactinemiahas been analyzed. In patients with newly diagnosed hyperprolactinemia (74 men, 145 women; aged 15-72 years), successful response to cabergoline treatment for 6 months was similar in women and men. Prolactin levels normalized more frequently in micro- than in macroadenoma patients (86% vs. 64%), without a sex difference (70% vs. 69%, p=0.9). The sizes of macro- and microprolactinomas were reduced by 38 ±29% to 52 ±24%, and there was no difference in the amount of tumor shrinkage between men and women [5]. Similarly, another study reports no sex difference in percentage reduction in tumour dimension [6]. In another clinical study of cabergoline treatment in patients with hyperprolactinemia, men had less likelihood of achieving normal prolactin levels than women (75% vs. 90%). However, considering that the large majority of men had a macroprolactinoma (86% vs. 38% for women), which correlates with higher prolactin levels, patient’s sex had no independent influence on success rates. When only microprolactinomas were considered, the outcome was similar in men and women (92% vs. 93%) [7].

Adverse effects

A retrospective case-record study (48 men, 52 women) found no significant differences in prevalence of tricuspid regurgitation at any valve between hyperprolatinaemic men and women receiving cabergoline [8].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).