Cabergoline (Dostinex)
Long-acting dopamine D2 receptor agonist.
- Cocaine use disorder2
- Prolactinemia2
Features
Dosing
Cocaine: 0.5 mg once per week (start 0.25 mg weekly for first 1-2 weeks)
Prolactinemia: Start 0.25 mg weekly, increase by 0.25 mg twice weekly every 4 weeks, guided by serum prolactin levels (typically measured every 8 weeks during titration). Typical dose is 0.5 mg twice/week, max 1.5 mg twice/week.
Management
TOLERABILITY: Nausea (27%), headache (26%), and dizziness (15%); hypotension, fatigue.
RISKS: Hallucinations and hedonic dysregulation (similar to pramipexole). Cardiac (valvulopathy and fibrosis); FDA recommends a baseline echocardiogram before initiation and surveillance echocardiograms every 6–12 months.
EMR Text
Cocaine
Cabergoline started based on randomized controlled trials in cocaine use disorder (Amin-Esmaeili M et al, JAMA Psychiatry 2026).
Cabergoline’s risks, including cardiac, psychosis, and hedonic dysregulation, reviewed with patient.
Prolactinemia
Cabergoline started based on randomized trials in prolactinemia (Ma K et al, Expert Opin Drug Saf. 2025;24(7):773-786).
Cabergoline’s risks, including cardiac, psychosis, and hedonic dysregulation, reviewed with patient.