When transferring patients from another
levodopa/dopa-decarboxylase inhibitor preparation, the
previous preparation should be discontinued at least
Co-careldopa 25/100 provides an adequate dose of
carbidopa when low doses of levodopa are needed.
l PATIENT AND CARER ADVICE Manufacturer advises
patients and their carers should be informed of the risk of
developing dopamine dysregulation syndrome; addictionlike symptoms should be reported.
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (June 2016)
that co-careldopa (Duodopa ®) intestinal gel is accepted for
restricted use within NHS Scotland, for the treatment of
advanced levodopa-responsive Parkinson’s disease with
severe motor fluctuations and hyper-/dyskinesia when
available combinations of Parkinson medicinal products
have not given satisfactory results, only in patients not
eligible for deep brain stimulation. This advice is
contingent upon the continuing availability of the Patient
Access Scheme in NHS Scotland or a list price that is
All Wales Medicines Strategy Group (AWMSG) decisions
The All Wales Medicines Strategy Group has advised (March
2018) that Duodopa ® intestinal gel is recommended as an
option for restricted use within NHS Wales, for the
treatment of advanced levodopa-responsive Parkinson’s
disease with severe motor fluctuations and hyper-
/dyskinesia when available combinations of Parkinson
medicinal products have not given satisfactory results,
only in patients not eligible for deep brain stimulation.
This recommendation applies only in circumstances where
the approved Wales Patient Access Scheme (WPAS) is
utilised or where the list/contract price is equivalent or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 10, 14, 25
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mg Caramet 25mg/100mg CR tablets | 60 tablet P £11.47
▶ Half Sinemet CR (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mg Half Sinemet CR 25mg/100mg tablets | 60 tablet P £11.60 DT = £11.60
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mg Lecado 100mg/25mg modified-release tablets | 60 tablet P £9.86 DT = £11.60
Carbidopa (as Carbidopa monohydrate) 50 mg, Levodopa
200 mg Lecado 200mg/50mg modified-release tablets |
▶ Sinemet CR (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 50 mg, Levodopa
200 mg Sinemet CR 50mg/200mg tablets | 60 tablet P £11.60
CAUTIONARY AND ADVISORY LABELS 10, 14
▶ Co-careldopa (Non-proprietary)
Carbidopa (as Carbidopa monohydrate) 12.5 mg, Levodopa
50 mg Co-careldopa 12.5mg/50mg tablets | 90 tablet P £6.28–
Carbidopa (as Carbidopa monohydrate) 10 mg, Levodopa
100 mg Co-careldopa 10mg/100mg tablets | 100 tablet P £13.50 DT = £12.20
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mg Co-careldopa 25mg/100mg tablets | 90 tablet P £5.71
| 100 tablet P £26.99 DT = £9.02
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
250 mg Co-careldopa 25mg/250mg tablets | 100 tablet P £35.00 DT = £34.98
▶ Sinemet 110 (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 10 mg, Levodopa
100 mg Sinemet 10mg/100mg tablets | 100 tablet P £7.30 DT =
▶ Sinemet 275 (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
250 mg Sinemet 25mg/250mg tablets | 100 tablet P £18.29 DT =
▶ Sinemet 62.5 (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 12.5 mg, Levodopa
50 mg Sinemet 12.5mg/50mg tablets | 90 tablet P £6.28 DT =
▶ Sinemet Plus (Merck Sharp & Dohme Ltd)
Carbidopa (as Carbidopa monohydrate) 25 mg, Levodopa
100 mg Sinemet Plus 25mg/100mg tablets | 100 tablet P £12.88
CAUTIONARY AND ADVISORY LABELS 10, 14
Carbidopa (as Carbidopa monohydrate) 5 mg per 1 ml, Levodopa
20 mg per 1 ml Duodopa intestinal gel 100ml cassette | 1 bag P £77.00
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, co-careldopa p. 415, entacapone p. 412.
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 10 tablets per
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 10 tablets per
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 10 tablets per
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 8 tablets per
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 7 tablets per
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 10 tablets per
Parkinson’s disease and end-of-dose motor fluctuations
not adequately controlled with levodopa and dopadecarboxylase inhibitor treatment
▶ Adult: 1 tablet for each dose; maximum 10 tablets per
l INTERACTIONS → Appendix 1: carbidopa . entacapone . levodopa
l PRESCRIBING AND DISPENSING INFORMATION Patients
receiving standard-release co-careldopa or co-beneldopa
alone, initiate Stalevo ® at a dose that provides similar (or
slightly lower) amount of levodopa.
Patients with dyskinesia or receiving more than 800 mg
levodopa daily, introduce entacapone before transferring
to Stalevo ® (levodopa dose may need to be reduced by
provides similar (or slightly higher) amount of levodopa.
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
with carbidopa with entacapone and levodopa.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 10, 14(urine reddish-brown),
▶ Stalevo (Orion Pharma (UK) Ltd)
Carbidopa 25 mg, Levodopa 100 mg, Entacapone 200 mg Stalevo
100mg/25mg/200mg tablets | 30 tablet P £20.79 DT = £20.79 | 100 tablet P £69.31 DT = £69.31
Carbidopa 18.75 mg, Levodopa 75 mg, Entacapone
Carbidopa 37.5 mg, Levodopa 150 mg, Entacapone
Carbidopa 12.5 mg, Levodopa 50 mg, Entacapone 200 mg Stalevo
50mg/12.5mg/200mg tablets | 30 tablet P £20.79 DT = £20.79 | 100 tablet P £69.31 DT = £69.31
Carbidopa 31.25 mg, Levodopa 125 mg, Entacapone
Carbidopa 43.75 mg, Levodopa 175 mg, Entacapone
Carbidopa 50 mg, Entacapone 200 mg, Levodopa 200 mg Stalevo
200mg/50mg/200mg tablets | 30 tablet P £20.79 DT = £20.79 | 100 tablet P £69.31 DT = £69.31
BNF 78 Parkinson’s disease 417
DOPAMINERGIC DRUGS › DOPAMINE RECEPTOR
Amantadine hydrochloride 08-Feb-2019
l DRUG ACTION Amantadine is a weak dopamine agonist
with modest antiparkinsonian effects.
▶ Adult: 100 mg daily for 1 week, then increased to
100 mg twice daily, usually administered in
conjunction with other treatment. Some patients may
require higher doses; maximum 400 mg per day
▶ Elderly: 100 mg daily, adjusted according to response
▶ Adult: 100 mg twice daily for 14 days (continued for
Treatment of influenza A (but not recommended)
▶ Adult: 100 mg daily 4–5 days
Prophylaxis of influenza A (but not recommended)
▶ Adult: 100 mg daily usually for 6 weeks or with
influenza vaccination for 2–3 weeks after vaccination
l CONTRA-INDICATIONS Epilepsy . history of gastric
l CAUTIONS Confused or hallucinatory states . congestive
heart disease (may exacerbate oedema). elderly .tolerance
to the effects of amantadine may develop in Parkinson’s
l INTERACTIONS → Appendix 1: dopamine receptor agonists
▶ Uncommon Neuroleptic malignant-like syndrome . psychosis . seizure .tremor
▶ Frequency not known Delirium
l PREGNANCY Avoid; toxicity in animal studies.
l BREAST FEEDING Avoid; present in milk; toxicity in infant
l HEPATIC IMPAIRMENT Manufacturer advises use with
l RENAL IMPAIRMENT Avoid if eGFR less than
l TREATMENT CESSATION Avoid abrupt withdrawal in
Driving and skilled tasks May affect performance of skilled
l NATIONAL FUNDING/ACCESS DECISIONS
▶ Oseltamivir, amantadine (review) and zanamivir for the
prophylaxis of influenza (September 2008) NICE TA158
Amantadine is not recommended for prophylaxis of
www.nice.org.uk/guidance/ta158
▶ Amantadine, oseltamivir and zanamivir for the treatment of
influenza (February 2009) NICE TA168
Amantadine is not recommended for treatment of
www.nice.org.uk/guidance/ta168
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: tablet
▶ Amantadine hydrochloride (Non-proprietary)
Amantadine hydrochloride 10 mg per 1 ml Amantadine 50mg/5ml
oral solution sugar free sugar-free | 150 ml P £118.00–£140.00
▶ Amantadine hydrochloride (Non-proprietary)
Apomorphine hydrochloride 13-Jun-2018
Refractory motor fluctuations in Parkinson’s disease (‘off’
episodes) inadequately controlled by co-beneldopa or
co-careldopa or other dopaminergics (for capable and
motivated patients) (under expert supervision)
▶ Adult: Initially 1 mg, dose to be administered at the
first sign of ‘off’ episode, then 2 mg after 30 minutes,
dose to be given if inadequate or no response following
initial dose, thereafter increase dose at minimum
40-minute intervals until satisfactory response
obtained, this determines threshold dose; usual dose
3–30 mg daily in divided doses (max. per dose 10 mg),
subcutaneous infusion may be preferable in those
requiring division of injections into more than
10 doses; maximum 100 mg per day
Refractory motor fluctuations in Parkinson’s disease (‘off’
episodes) inadequately controlled by co-beneldopa or
co-careldopa or other dopaminergics (in patients
requiring division into more than 10 injections daily)
▶ BY CONTINUOUS SUBCUTANEOUS INFUSION
▶ Adult: Initially 1 mg/hour, adjusted according to
response, then increased in steps of up to
500 micrograms/hour, dose to be increased at intervals
not more often than every 4 hours; usual dose
1–4 mg/hour, alternatively usual dose
15–60 micrograms/kg/hour, change infusion site every
12 hours and give during waking hours only (tolerance
may occur unless there is a 4-hour treatment-free
period at night—24-hour infusions not recommended
unless severe night time symptoms); intermittent
bolus doses may be needed; maximum 100 mg per day
Treatment with dopamine-receptor agonists are
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist or
levodopa should be withdrawn or the dose reduced until
l CONTRA-INDICATIONS Avoid if ‘on’ response to levodopa
marred by severe dyskinesia or dystonia . dementia . psychosis .respiratory depression
l CAUTIONS Cardiovascular disease . history of postural
hypotension (special care on initiation). neuropsychiatric
conditions . pulmonary disease . susceptibility to QTinterval prolongation
l INTERACTIONS → Appendix 1: dopamine receptor agonists
▶ Rare or very rare Bronchospasm . eosinophilia . hypersensitivity
▶ Frequency not known Aggression . agitation . dopamine
dysregulation syndrome . eating disorders . pathological
gambling . peripheral oedema . sexual dysfunction . syncope
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated if
history of hypersensitivity to opioids.
l PREGNANCY Avoid unless clearly necessary.
l BREAST FEEDING No information available; may suppress
l HEPATIC IMPAIRMENT Manufacturer advises avoid in
l RENAL IMPAIRMENT Use with caution.
▶ Monitor hepatic, haemopoietic, renal, and cardiovascular
▶ With concomitant levodopa test initially and every 6 months
for haemolytic anaemia and thrombocytopenia
(development calls for specialist haematological care with
dose reduction and possible discontinuation).
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
l PATIENT AND CARER ADVICE Manufacturer advises
patients and their carers should be informed of the risk of
developing dopamine dysregulation syndrome; addictionlike symptoms should be reported.
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
with dopamine-receptor agonists.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Drugs and driving Prescribers and other healthcare
professionals should advise patients if treatment is likely
to affect their ability to perform skilled tasks (e.g. driving).
This applies especially to drugs with sedative effects;
patients should be warned that these effects are increased
by alcohol. General information about a patient’s fitness to
drive is available from the Driver and Vehicle Licensing
2015 legislation regarding driving whilst taking certain
drugs, may also apply to apomorphine, see Drugs and
driving under Guidance on prescribing p. 1.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: solution for
injection, solution for infusion
CAUTIONARY AND ADVISORY LABELS 10
EXCIPIENTS: May contain Sulfites
▶ APO-go (Britannia Pharmaceuticals Ltd)
Apomorphine hydrochloride 10 mg per 1 ml APO-go 50mg/5ml
solution for injection ampoules | 5 ampoule P £73.11 DT = £73.11
▶ APO-go Pen (Britannia Pharmaceuticals Ltd)
Apomorphine hydrochloride 10 mg per 1 ml APO-go PEN
30mg/3ml solution for injection | 5 pre-filled disposable
injection P £123.91 DT = £123.91
▶ Dacepton (Ever Pharma UK Ltd)
Apomorphine hydrochloride hemihydrate 10 mg per
1 ml Dacepton 30mg/3ml solution for injection cartridges | 5 cartridge P £123.00
CAUTIONARY AND ADVISORY LABELS 10
EXCIPIENTS: May contain Sulfites
▶ APO-go PFS (Britannia Pharmaceuticals Ltd)
Apomorphine hydrochloride 5 mg per 1 ml APO-go PFS
50mg/10ml solution for infusion pre-filled syringes | 5 pre-filled
disposable injection P £73.11 DT = £73.11
▶ Dacepton (Ever Pharma UK Ltd)
Apomorphine hydrochloride hemihydrate 5 mg per
1 ml Dacepton 100mg/20ml solution for infusion vials | 5 vial P £145.00
l DRUG ACTION Bromocriptine is a stimulant of dopamine
receptors in the brain; it also inhibits release of prolactin
▶ Adult: Initially 2.5 mg daily for 1 day, then 2.5 mg twice
▶ Adult: Initially 2.5 mg daily for 2–3 days, then 2.5 mg
Hypogonadism | Galactorrhoea | Infertility
▶ Adult: Initially 1–1.25 mg daily, dose to be taken at
bedtime, increase dose gradually; usual dose 7.5 mg
daily in divided doses, increased if necessary up to
30 mg daily, usual dose in infertility without
hyperprolactinaemia is 2.5 mg twice daily
▶ Adult: Initially 1–1.25 mg daily, dose to be taken at
bedtime, then increased to 5 mg every 6 hours, increase
▶ Adult: Initially 1–1.25 mg daily, dose to be taken at
bedtime, then increased to 5 mg every 6 hours, increase
dose gradually. Occasionally patients may require up to
▶ Adult: Initially 1–1.25 mg daily for 1 week, dose to be
taken at night, then 2–2.5 mg daily for 1 week, dose to
be taken at night, then 2.5 mg twice daily for 1 week,
then 2.5 mg 3 times a day for 1 week, then continued→
BNF 78 Parkinson’s disease 419
increased in steps of 2.5 mg every 3–14 days, adjusted
according to response; maintenance 10–30 mg daily
Bromocriptine has been associated with pulmonary,
retroperitoneal, and pericardial fibrotic reactions.
Exclude cardiac valvulopathy with echocardiography
before starting treatment with these ergot derivatives for
Parkinson’s disease or chronic endocrine disorders
(excludes suppression of lactation); it may also be
appropriate to measure the erythrocyte sedimentation
rate and serum creatinine and to obtain a chest X-ray.
Patients should be monitored for dyspnoea, persistent
cough, chest pain, cardiac failure, and abdominal pain or
tenderness. If long-term treatment is expected, then
lung-function tests may also be helpful.
Treatment with dopamine-receptor agonists are
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist should
be withdrawn or the dose reduced until the symptoms
l CONTRA-INDICATIONS Avoid in pre-eclampsia . cardiac
valvulopathy (exclude before treatment). hypertension in
postpartum women or in puerperium
CONTRA-INDICATIONS, FURTHER INFORMATION
▶ Postpartum or puerperium Should not be used postpartum or
in puerperium in women with high blood pressure,
coronary artery disease, or symptoms (or history) of
serious mental disorder; monitor blood pressure carefully
(especially during first few days) in postpartum women.
Very rarely hypertension, myocardial infarction, seizures
or stroke (both sometimes preceded by severe headache or
visual disturbances), and mental disorders have been
reported in postpartum women given bromocriptine for
lactation suppression—caution with antihypertensive
therapy and avoid other ergot alkaloids. Discontinue
immediately if hypertension, unremitting headache, or
signs of CNS toxicity develop.
l CAUTIONS Cardiovascular disease . history of peptic ulcer
(particularly in acromegalic patients). history of serious
mental disorders (especially psychotic disorders). Raynaud’s syndrome
▶ Hyperprolactinemic patients In hyperprolactinaemic patients,
the source of the hyperprolactinaemia should be
established (i.e. exclude pituitary tumour before
l INTERACTIONS → Appendix 1: dopamine receptor agonists
▶ Common or very common Constipation . drowsiness . headache . nasal congestion . nausea
▶ Rare or very rare Abdominal pain . arrhythmias . cardiac
valvulopathy . diarrhoea . dyspnoea . gastrointestinal
disorders . gastrointestinal haemorrhage . neuroleptic
psychotic disorder.respiratory disorders . sleep disorders . tinnitus . vision disorders
disorders . seizure . sexual dysfunction . stroke
SIDE-EFFECTS, FURTHER INFORMATION Treatment should
be withdrawn if gastro-intestinal bleeding occurs.
l ALLERGY AND CROSS-SENSITIVITY Bromocriptine should
not be used in patients with hypersensitivity to ergot
l CONCEPTION AND CONTRACEPTION Caution—provide
contraceptive advice if appropriate (oral contraceptives
may increase prolactin concentration).
l BREAST FEEDING Suppresses lactation; avoid breast
feeding for about 5 days if lactation prevention fails.
Dose adjustments Manufacturer advises dose adjustment
may be necessary—risk of increased plasma concentration.
▶ Specialist evaluation—monitor for pituitary enlargement,
particularly during pregnancy; monitor visual field to
detect secondary field loss in macroprolactinoma.
▶ Monitor for fibrotic disease.
▶ Monitor blood pressure for a few days after starting
treatment and following dosage increase.
l TREATMENT CESSATION Antiparkinsonian drug therapy
should never be stopped abruptly as this carries a small
risk of neuroleptic malignant syndrome.
Driving and skilled tasks Sudden onset of sleep Excessive
daytime sleepiness and sudden onset of sleep can occur
with dopamine-receptor agonists.
Patients starting treatment with these drugs should be
warned of the risk and of the need to exercise caution
when driving or operating machinery. Those who have
experienced excessive sedation or sudden onset of sleep
should refrain from driving or operating machines until
these effects have stopped occurring.
Management of excessive daytime sleepiness should
focus on the identification of an underlying cause, such as
depression or concomitant medication. Patients should be
counselled on improving sleep behaviour.
Hypotensive reactions Hypotensive reactions can occur in
some patients taking dopamine-receptor agonists; these
can be particularly problematic during the first few days of
treatment and care should be exercised when driving or
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
CAUTIONARY AND ADVISORY LABELS 10, 21
▶ Bromocriptine (Non-proprietary)
Bromocriptine (as Bromocriptine mesilate) 1 mg Bromocriptine
1mg tablets | 100 tablet P £67.66 DT = £67.66
Bromocriptine (as Bromocriptine mesilate) 2.5 mg Bromocriptine
2.5mg tablets | 30 tablet P £74.97 DT = £74.97
CAUTIONARY AND ADVISORY LABELS 10, 21
▶ Parlodel (Meda Pharmaceuticals Ltd)
Bromocriptine (as Bromocriptine mesilate) 5 mg Parlodel 5mg
capsules | 100 capsule P £37.57 DT = £37.57
Bromocriptine (as Bromocriptine mesilate) 10 mg Parlodel 10mg
capsules | 100 capsule P £69.50 DT = £69.50
l DRUG ACTION Cabergoline is a stimulant of dopamine
receptors in the brain and it also inhibits release of
▶ Adult: 1 mg, to be taken as a single dose on the first day
Suppression of established lactation
▶ Adult: 250 micrograms every 12 hours for 2 days
▶ Adult: Initially 500 micrograms once weekly, dose may
be taken as a single dose or as 2 divided doses on
separate days, then increased in steps of
500 micrograms every month until optimal therapeutic
response reached, increase dose following monthly
monitoring of serum prolactin levels; usual dose
0.25–2 mg once weekly, usually 1 mg weekly; reduce
initial dose and increase more gradually if patient
intolerant, doses over 1 mg weekly to be given as
divided dose; maximum 4.5 mg per week
Alone or as adjunct to co-beneldopa or co-careldopa in
Parkinson’s disease where dopamine-receptor agonists
other than ergot derivative not appropriate
▶ Adult: Initially 1 mg daily, then increased in steps of
0.5–1 mg every 7–14 days, concurrent dose of levodopa
may be decreased gradually while dose of cabergoline is
increased; maximum 3 mg per day
Cabergoline has been associated with pulmonary,
retroperitoneal, and pericardial fibrotic reactions.
Exclude cardiac valvulopathy with echocardiography
before starting treatment with these ergot derivatives for
Parkinson’s disease or chronic endocrine disorders
(excludes suppression of lactation); it may also be
appropriate to measure the erythrocyte sedimentation
rate and serum creatinine and to obtain a chest X-ray.
Patients should be monitored for dyspnoea, persistent
cough, chest pain, cardiac failure, and abdominal pain or
tenderness. If long-term treatment is expected, then
lung-function tests may also be helpful. Patients taking
cabergoline should be regularly monitored for cardiac
fibrosis by echocardiography (within 3–6 months of
initiating treatment and subsequently at 6–12 month
Treatment with dopamine-receptor agonists are
associated with impulse control disorders, including
pathological gambling, binge eating, and hypersexuality.
Patients and their carers should be informed about the
risk of impulse control disorders. There is no evidence
that ergot- and non-ergot-derived dopamine-receptor
agonists differ in their propensity to cause impulse
recommended. If the patient develops an impulse
control disorder, the dopamine-receptor agonist should
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