Cabergoline

Pharmacologic Category

Ergot Derivative

Dosing: Adult

Hyperprolactinemic disorders: Oral:

US labeling: Initial: 0.25 mg twice weekly; the dose may be increased by 0.25 mg twice weekly up to a maximum of 1 mg twice weekly according to the patient's serum prolactin level. Dosage increases should not occur more rapidly than every 4 weeks. Once a normal serum prolactin level is maintained for 6 months, discontinue cabergoline and monitor prolactin levels to determine if cabergoline should be reinstituted. The durability of efficacy beyond 24 months of therapy has not been established.

Canadian labeling: Initial: 0.5 mg once weekly or 0.25 mg twice weekly; weekly dose may be increased by 0.5 mg per week at 4 week intervals until optimal therapeutic response. Therapeutic dose: Usual: 1 mg/week (range: 0.25 to 2 mg/week). Once a normal serum prolactin level is maintained for 6 months, discontinue cabergoline and monitor prolactin levels to determine if cabergoline should be reinstituted. Note: May divide weekly dose into 2 or more divided doses per week (recommended for doses >1 mg/week) based on tolerability.

Lactation inhibition (Canadian labeling; not in the US labeling): Oral: 1 mg single dose on first day postpartum.

Lactation inhibition in women living with HIV (off-label use): Oral: 1 mg single dose on first day postpartum (HHS [perinatal 2019]).

Acromegaly (off-label use): Oral: Initial: 0.25 to 0.5 mg two times per week; titrate as needed per insulin-like growth factor 1 (IGF-1) and growth hormone levels every 4 to 6 weeks; commonly studied doses ranged from 0.5 to 3.5 mg/week (mean dose ~2 mg/week) (AACE [Katznelson 2011]; Abs 1998; Cozzi 2004; Moyes 2008; Vilar 2001); in a few patients doses up to 7 mg/week were studied (Abs 1998; Moyes 2008). In some poorly responsive patients, doses >2 mg/week were not more efficacious in suppressing IGF-1 (Abs 1998).

Cushing syndrome (off-label use): Oral: Initial: 0.5 mg once weekly or 1 mg weekly (given as 0.5 mg twice weekly); may increase by 0.5 to 1 mg weekly at 1- or 2-month intervals until complete and sustained normalization of urinary free cortisol levels; maximum: 7 mg weekly (given as 1 mg once daily) (ES [Neiman 2015]; Godbout 2010; Pivonello 2009)

Restless legs syndrome (off-label use): Oral: Initial: 0.5 mg, 3 hours before bedtime; titrate in 0.5 mg increments every 3 to 7 days; usual dose: 2 mg; doses as high as 7 mg have been studied (Aurora 2012; Oertel 2006; Stiasny-Kolster 2004; Trenkwalder 2007).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing. Start at the low end of the dosage range.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; however, cabergoline pharmacokinetics are not altered in patients with moderate to severe renal impairment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution and monitor carefully in patients with severe hepatic impairment (Child-Pugh class C) (extensive hepatic metabolism).

Use: Labeled Indications

Hyperprolactinemic disorders: Treatment of hyperprolactinemic disorders, either idiopathic or caused by pituitary adenomas.

Limitations of use: Not indicated for inhibition or suppression of physiologic lactation.

Canadian labeling: Additional use (not in US labeling): Prevention of the onset of physiological lactation in the puerperium when clinically indicated (eg, still born baby or neonatal death, conditions that interfere with suckling, severe acute or chronic mental illness, maternal disease which may be transmitted to the baby that require medications which are excreted in the milk).

Limitations of use: Not indicated for suppression of already established postpartum lactation.

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

AcromegalyLevel of Evidence [C, G]

Data from prospective, open-label studies and retrospective studies suggest cabergoline may be effective in the treatment of patients with acromegaly who have modest elevations of insulin-like growth factor 1 (IGF-1) and mild signs/symptoms of growth hormone (GH) excess ^Ref.

The American Association of Clinical Endocrinologists medical guidelines for the diagnosis and treatment of acromegaly, the Endocrine Society Clinical practice guidelines for acromegaly, and the Acromegaly Consensus Group consensus statement on acromegaly therapeutic outcomes suggest that a trial of cabergoline may be used as initial adjuvant therapy for mild residual disease (eg, IGF-1 levels <2.5 times ULN) following transsphenoidal surgery or as primary initial therapy in patients with mild disease who are poor surgical candidates. In patients with an inadequate response to somatostatin analog therapy and IGF-1 levels <2.5 times ULN, cabergoline may be added as part of second-line medical therapy ^Ref.

Cushing syndromeLevel of Evidence [G]

Based on the Endocrine Society's Clinical Practice Guidelines for Treatment of Cushing's Syndrome, cabergoline is suggested as a medical pituitary-directed treatment for patients with Cushing syndrome who are not surgical candidates or who have persistent disease after transsphenoidal surgery (TSS). Of note, pituitary-directed treatments such as cabergoline are generally not effective in adrenal causes of Cushing disease.

Lactation inhibition in women living with HIVLevel of Evidence [C, G]

Based on data from a small prospective cohort study and a small retrospective cohort study of women living with HIV, as well as reviews of this use in women without HIV, cabergoline may be useful for preventing the onset of physiological lactation in the puerperium ^Ref.

The Health and Human Services (HHS) Perinatal HIV guidelines note use of a single dose of cabergoline administered the first day after delivery may be considered for lactation suppression in select women living with HIV. Use is not recommended for women with hypertension (including pregnancy-induced hypertension, preeclampsia, or eclampsia), hepatic disease, women being treated with antipsychotics, or women with a history of puerperal psychosis ^Ref.

Restless legs syndromeLevel of Evidence [B, G]

Data from a meta-analysis support the use of cabergoline in the treatment of restless legs syndrome (RLS) ^Ref.

Based on the American Academy of Neurology practice guidelines for the treatment of RLS in adults, cabergoline should be considered for the treatment of patients with moderate to severe primary RLS; use may specifically improve periodic limb movements of sleep and subjective sleep measures. According to the AAN guidelines, fibrotic complications/cardiac valvulopathy generally does not occur at the lower doses used for the treatment of RLS.

Based on the American Academy of Sleep Medicine practice parameters for the treatment of RLS and periodic limb movement disorder in adults, cabergoline is only recommended for the treatment of moderate to very severe RLS in patients who have failed previous therapies, due to the risk of cardiac valve regurgitation ^Ref. The guidelines on the management of RLS published by the European Federation of Neurological Societies, the European Neurological Society, and the European Sleep Research Society recommend against the use of cabergoline in RLS due to the risk of cardiac valve regurgitation ^Ref. Access Full Off-Label Monograph

Level of Evidence Definitions

Level of Evidence Scale

Clinical Practice Guidelines

Acromegaly:

Acromegaly Consensus Group, "A Consensus Statement on Acromegaly Therapeutic Outcomes," September 2018

Endocrine Society, "Acromegaly: An Endocrine Society Clinical Practice Guideline," November 2014

Cushing Syndrome:

Endocrine Society, “Treatment of Cushing’s Syndrome,” August 2015

Hyperprolactinemia:

Endocrine Society, "Diagnosis and treatment of Hyperprolactinemia," 2011

Restless Legs Syndrome:

American Academy of Neurology, “Treatment of Restless Legs Syndrome in Adults,” 2016

American Academy of Sleep Medicine, "The treatment of restless legs syndrome and periodic limb movement disorder in adults - An update for 2012: Practice parameters with an evidence-based systematic review and meta-analysis," 2012

European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society, “European guidelines on management of restless legs syndrome: Report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society,” November 2012

Administration: Oral

Administer with meals (may increase tolerability).

Dietary Considerations

Take with food.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 3]).

Use appropriate precautions for receiving, handling, administration, and disposal. Gloves (single) should be worn during receiving, unpacking, and placing in storage. NIOSH recommends single gloving for administration of intact tablets or capsules (NIOSH 2016). Assess risk to determine appropriate containment strategy (USP-NF 2017).

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F). Dispense in original container.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat health problems where there are high prolactin levels.

• It may be given to you for other reasons. Talk with the doctor.

Frequently reported side effects of this drug

• Constipation

• Nausea

• Loss of strength and energy

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Severe cerebrovascular disease like change in strength on one side is greater than the other, trouble speaking or thinking, change in balance, or vision changes.

• Kidney problems like unable to pass urine, blood in the urine, change in amount of urine passed, or weight gain.

• Abnormal heartbeat

• Fast heartbeat

• Shortness of breath

• Chest pain

• Persistent cough

• Severe dizziness

• Passing out

• Behavioral changes

• Uncontrollable urges

• Back pain

• Abdominal pain

• Excessive weight gain

• Swelling of arms or legs

• Severe headache

• Seizures

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Contraindications

Known hypersensitivity to cabergoline, ergot derivatives, or any component of the formulation; uncontrolled hypertension; history of cardiac valvular disorders (indicated by valvulopathy of any valve, thickening of valve leaflet, valve restriction, or mixed valve restriction stenosis); history of pulmonary, pericardial, or retroperitoneal fibrotic disorders.

Warnings/Precautions

Concerns related to adverse effects:

• Cardiac valvulopathy: Cardiac valvulopathy has been reported with use. Cardiovascular evaluation (eg. chest x-ray, CT scan, echocardiogram) is necessary prior to initiating treatment; do not start therapy if valvular disease is detected. During treatment, the lowest effective dose should be utilized (incidence may be higher for daily doses >2 mg). Discontinue if an echocardiogram reveals new valvular regurgitation, valvular restriction, or valve leaflet thickening.

• Cardiovascular effects: Initial doses >1 mg may cause orthostatic hypotension; may be symptomatic. Use with caution in patients with cardiovascular disease; hypertension, stroke, and seizure have been reported with other dopamine agonists. Concurrent use with antihypertensives may increase risk.

• CNS depression: May cause somnolence, which may impair physical or mental abilities; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving).

• Pleural/retroperitoneal fibrosis: Cases of pleural, pericardial, and retroperitoneal fibrosis have been reported. Do not use in patients with a history of cardiac or extracardiac fibrotic disorders. Following diagnosis of fibrosis, discontinuation of cabergoline may result in improvement of condition.

• Psychiatric disorders: Aggression, psychotic behavior, and impulse control disorders such as pathological gambling, increased libido, hypersexuality, compulsive spending or buying, and binge-eating have been reported with use; generally reversible with dose reduction or discontinuation of treatment.

Disease-related concerns:

• Hepatic impairment: Use with caution and carefully monitor patients with hepatic impairment; extensive hepatic metabolism.

• Peptic ulcer disease: Use with caution in patients with peptic ulcer disease (PUD) or GI bleeding.

• Raynaud syndrome: Use with caution in patients with Raynaud syndrome.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

* See Cautions in AHFS Essentials for additional information.

Pregnancy Considerations

Information related to the use of cabergoline for the treatment of hyperprolactinemia in pregnancy is available but limited compared to the use of other agents (Almistehi 2018; Auriemma 2013; Colao 2008; Lebbe 2010; Moltich 2015; Ricci 2002; Robert 1996; Stalldecker 2010). Although available evidence suggests cabergoline use early in pregnancy does not cause harm to the fetus, it is recommended that therapy be discontinued once pregnancy is discovered. If treatment of hyperprolactinemia during pregnancy is required, cabergoline may be used, but other agents are preferred. Monitoring of prolactin levels should be suspended during pregnancy (Endocrine Society [Melmed 2011]). If treatment for acromegaly (off-label use) is required during pregnancy for worsening symptoms (such as headache) or evidence of tumor growth, use of cabergoline may be considered. Monitoring of insulin-like growth factor 1 and/or growth hormone (GH) are not recommended during pregnancy as an active placental GH variant present in maternal blood limits the usefulness of the results (Endocrine Society [Katznelson 2014]). Information related to cabergoline for the treatment of Cushing Syndrome (off-label use) during pregnancy is limited; agents other than cabergoline are recommended (Nakhleh 2016; Nieman 2015; Sek 2017).

Cabergoline is contraindicated in patients with uncontrolled hypertension; use is not recommended by the manufacturer in women with pregnancy-induced hypertension (eg, preeclampsia, eclampsia, postpartum hypertension) unless benefit outweighs potential risk.

Dose-related decreases in prolactin occur with cabergoline therapy. Treatment may restore fertility in previously infertile women.

Breast-Feeding Considerations

It is not known if cabergoline is present in breast milk.

Cabergoline interferes with lactation and should not be given to women postpartum who are breastfeeding or who are planning to breastfeed.

In the US labeling, cabergoline is not indicated for the inhibition or suppression of physiologic lactation. If used off label to decrease milk production in breastfeeding women with an overabundant milk supply (hypergalactia) who do not respond to preferred therapies, breast milk should be discarded for ~5 days after using cabergoline (Eglash 2014).

Breastfeeding is not recommended for women living with HIV. The Health and Human Services (HHS) Perinatal HIV guidelines note use of a single dose of cabergoline may be considered for lactation suppression in select women living with HIV. If used for this purpose, cabergoline should not be used in women with hypertension (including pregnancy-induced hypertension, preeclampsia, or eclampsia), hepatic disease, women being treated with antipsychotics, or women with a history of puerperal psychosis. Prior to cabergoline off-label use, women should be informed of the limited data related to this off-label use, side effects of treatment, use other of nonpharmacologic options, and limitations of health insurance reimbursement (HHS [perinatal 2019]).

Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of treatment to the mother.

Briggs' Drugs in Pregnancy & Lactation

• Cabergoline

Adverse Reactions

>10%:

Gastrointestinal: Nausea (27% to 29%)

Nervous system: Headache (26%), dizziness (15% to 17%)

1% to 10%:

Cardiovascular: Orthostatic hypotension (4%), peripheral edema (1%), hypotension (≤1%), palpitations (≤1%), syncope (≤1%)

Dermatologic: Acne vulgaris (≤1%), pruritus (≤1%)

Endocrine & metabolic: Hot flash (3%), dependent edema (1%)

Gastrointestinal: Constipation (7% to 10%), abdominal pain (5%), dyspepsia (2% to 5%), vomiting (2% to 4%), diarrhea (≤2%), flatulence (≤2%), xerostomia (≤2%), toothache (1%), anorexia (≤1%)

Genitourinary: Mastalgia (1% to 2%), dysmenorrhea (≤1%)

Nervous system: Fatigue (5% to 7%), vertigo (1% to 4%), depression (3%), pain (2%), drowsiness (≤2%), nervousness (≤2%), paresthesia (≤2%), lack of concentration (1%), anxiety (≤1%), insomnia (≤1%), malaise (≤1%)

Neuromuscular & skeletal: Asthenia (6%), arthralgia (1%)

Ophthalmic: Periorbital edema (1%), visual disturbance (≤1%)

Respiratory: Rhinitis (1%), throat irritation (1%), flu-like symptoms (≤1%)

<1%, postmarketing, and/or case reports: Aggressive behavior, alopecia, epistaxis, facial edema, heart valve disease, impulse control disorder, increased libido (including hypersexuality), pathological gambling, pericardial effusion, pleural effusion, psychosis, pulmonary fibrosis, retroperitoneal fibrosis, weight gain, weight loss

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Ergot Alkaloid Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

Alpha-/Beta-Agonists: Ergot Derivatives may enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Risk X: Avoid combination

Alpha1-Agonists: Ergot Derivatives may enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Risk X: Avoid combination

Amisulpride: May diminish the therapeutic effect of Cabergoline. Cabergoline may diminish the therapeutic effect of Amisulpride. Risk X: Avoid combination

Beta-Blockers: May enhance the vasoconstricting effect of Ergot Derivatives. Risk D: Consider therapy modification

Chloroprocaine: May enhance the hypertensive effect of Ergot Derivatives. Risk C: Monitor therapy

Clarithromycin: May increase the serum concentration of Cabergoline. Risk C: Monitor therapy

Lorcaserin (Withdrawn From US Market): May enhance the adverse/toxic effect of Ergot Derivatives. Specifically, use of these drugs together may increase the risk of developing valvular heart disease. Lorcaserin (Withdrawn From US Market) may enhance the serotonergic effect of Ergot Derivatives. This could result in serotonin syndrome. Risk X: Avoid combination

Nefazodone: Ergot Derivatives may enhance the serotonergic effect of Nefazodone. This could result in serotonin syndrome. Nefazodone may increase the serum concentration of Ergot Derivatives. Risk X: Avoid combination

Nitroglycerin: Ergot Derivatives may diminish the vasodilatory effect of Nitroglycerin. This is of particular concern in patients being treated for angina. Nitroglycerin may increase the serum concentration of Ergot Derivatives. Risk X: Avoid combination

Pipamperone [INT]: Cabergoline may diminish the therapeutic effect of Pipamperone [INT]. Pipamperone [INT] may diminish the therapeutic effect of Cabergoline. Risk X: Avoid combination

Reboxetine: May enhance the hypertensive effect of Ergot Derivatives. Risk C: Monitor therapy

Serotonergic Agents (High Risk): Ergot Derivatives may enhance the serotonergic effect of Serotonergic Agents (High Risk). This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity (eg, hyperreflexia, clonus, hyperthermia, diaphoresis, tremor, autonomic instability, mental status changes) when these agents are combined. Exceptions: Nefazodone. Risk C: Monitor therapy

Serotonin 5-HT1D Receptor Agonists (Triptans): May enhance the vasoconstricting effect of Ergot Derivatives. Ergot Derivatives may enhance the vasoconstricting effect of Serotonin 5-HT1D Receptor Agonists (Triptans). Risk X: Avoid combination

Sulpiride: Cabergoline may diminish the therapeutic effect of Sulpiride. Sulpiride may diminish the therapeutic effect of Cabergoline. Risk X: Avoid combination

Monitoring Parameters

Blood pressure (both sitting/supine and standing); serum prolactin level (monthly until normalized); echocardiogram (at baseline and every 6 to 12 months or as needed during therapy); erythrocyte sedimentation rate, chest x-ray, and serum creatinine (at baseline and during therapy as needed); signs and symptoms of pleuropulmonary disease, renal insufficiency, ureteral/abdominal vascular obstruction, and cardiac failure.

Acromegaly (off-label use): Insulin-like growth factor 1 (IGF-1), growth hormone, and prolactin every 4 to 6 weeks after dose adjustment then every 4 to 6 months after normalization of IGF-1 (AACE [Katznelson 2011]; Abs 1998; ACG [Melmed 2018]).

Reference Range

Acromegaly (off-label use): Age-normalized serum insulin-like growth factor 1 (IGF-1) and a random growth hormone (GH) <1 mcg/L correlate with disease control; consider targeting postoperative GH level <0.4 mcg/L if ultra-sensitive GH assay is available; use of the same IGF-1 and GH assay in the same patient throughout management is suggested (ES [Katznelson 2014]; ACG [Melmed 2018]).

Advanced Practitioners Physical Assessment/Monitoring

Obtain serum prolactin level (monthly until normal), erythrocyte sedimentation rate, and serum creatinine (baseline and as needed). Monitor blood pressure (supine and standing). Obtain echocardiogram at baseline and then every 6 to 12 months or as needed and chest x-ray. Assess for signs and symptoms of pleuropulmonary disease, renal insufficiency, heart failure, and ureteral/abdominal vascular obstruction. Assess other medicines patient may be taking; alternate therapy or dosage adjustments may be needed.

Nursing Physical Assessment/Monitoring

Check ordered labs and tests and report abnormalities. Monitor for signs and symptoms of hypotension, cardiopulmonary symptoms, amenorrhea, and mental status changes; instruct patient to report.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 0.5 mg

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Dostinex: 0.5 mg

Generic: 0.5 mg

Anatomic Therapeutic Chemical (ATC) Classification

• G02CB03
• N04BC06

Generic Available (US)

Yes

Pricing: US

Tablets (Cabergoline Oral)

0.5 mg (per each): $34.61 - $36.66

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Cabergoline is a long acting dopamine receptor agonist with a high affinity for D₂ receptors; prolactin secretion by the anterior pituitary is predominantly under hypothalamic inhibitory control exerted through the release of dopamine. It is a potent 5-HT_2B-receptor agonist, which may contribute to observed fibrotic/valvulopathic events.

Pharmacodynamics/Kinetics

Distribution: Extensive, particularly to the pituitary

Protein binding: 40% to 42%

Metabolism: Extensively hepatic via hydrolysis; minimal CYP mediated metabolism

Half-life elimination: 63 to 69 hours

Time to peak, plasma: 2 to 3 hours

Excretion: Primarily feces (~60%); urine (~22%, <4% as unchanged drug)

Pharmacodynamics/Kinetics: Additional Considerations

Hepatic function impairment: Patients with severe insufficiency (Child-Pugh score >10) show a substantial increase in the mean cabergoline C_max and AUC.

Local Anesthetic/Vasoconstrictor Precautions

Cabergoline is a semisynthetic ergot alkaloid derivative; there is a possibility that it has vasoconstricting effects; use vasoconstrictor with caution

Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation), throat irritation, and toothache.

Effects on Bleeding

No information available to require special precautions

Related Information

• Safe Handling of Hazardous Drugs

Index Terms

Dostinex

FDA Approval Date

December 23, 1996

References

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Brand Names: International

Alactin (UA); Argolin (BD); Cabaser (AR, AU, CH, DK, FI, GB, IE, IT, SE); Cabergoline-Pharmacia (LU); Caberlin (IN, LK); Cabexa (HR); Cabolin (BD); Cabotrim (IL); Carbostinex (EG); Caverlactin (KR); Dostinex (AE, AR, AT, AU, BE, BG, BH, BR, CH, CL, CO, CR, CY, CZ, DE, DK, DO, EC, EE, EG, ES, FI, FR, GB, GR, GT, HK, HN, IE, IL, IQ, IR, IS, IT, JO, KR, KW, LB, LT, LU, LV, LY, MT, MX, MY, NI, NL, NO, NZ, OM, PA, PE, PL, PT, QA, RO, RU, SA, SE, SG, SI, SK, SV, SY, TR, TW, UA, UY, VE, YE, ZA); Ergolex (EG); Jakaranda (EG); Lactinese (PE); Proctin (LB); Prolastat (CO, EC); Sostilar (BE); Triaspar (AR)

Last Updated 3/6/20