Cabergoline

INTRODUCTION

Indications

Treatment of hyperprolactinemia (idiopathic or pituitary in origin). Unlabeled Use: Adjunctive treatment of Parkinson's disease.

Action

Inhibits secretion of prolactin by acting as a dopamine agonist. In Parkinson's disease, dopamine agonists directly stimulate neural dopamine receptors. Therapeutic Effects: Decreased secretion of prolactin in hyperprolactinemia. Reduced involuntary movements associated with Parkinson's disease.

Adverse Reactions/Side Effects

CNS: dizziness, headache, depression, drowsiness, fatigue, nervousness, vertigo, weakness. Resp: PULMONARY FIBROSIS, pleural effusion. EENT: abnormal vision. CV: VALVULAR DISORDERS, orthostatic hypotension, hot flashes. GI: constipation, nausea, abdominal pain, dyspepsia, vomiting. GU: dysmenorrhea. Endo: breast pain. Neuro: paresthesia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess any breathing problems, and report signs of pulmonary fibrosis or pleural effusion such as dry cough, wheezing, chest pain, shortness of breath, and difficult or labored breathing. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Assess heart sounds to monitor possible valvular disorders (See Appendices H). Report any abnormal sounds or symptoms of cardiac dysfunction, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• If treating increased prolactin secretion (hyperprolactinemia), monitor symptoms in women such as menstrual irregularities and abnormal lactation, and symptoms in men such as erectile dysfunction, breast enlargement, and decreased libido. Document whether drug therapy is successful in reducing these symptoms.

• If treating Parkinson disease, assess gait and motor function to help determine antiparkinson effects, especially when starting drug therapy or during dosing changes or addition of other antiparkinson drugs. Motor function should be assessed at different times of the day, such as when drugs are reaching peak therapeutic levels (i.e., 30–60 min after oral dose), as well as when drug effects are minimal (just before the next dose).

• Assess blood pressure when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic blood pressure (BP) falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Assess signs of paresthesia (numbness, tingling) or muscle twitching. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Monitor depression, nervousness, or other psychologic problems. Repeated or excessive symptoms may require change in dose or medication.

• Assess dizziness, drowsiness, or vertigo that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• For patients with Parkinson disease, implement therapeutic exercises (coordination exercises, gait training, cardiovascular conditioning) to complement ...