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prolactinoma, side effects of Cabergoline
Dear Doc,
I'm female, 46 years. Sorry for my bad english. I have been diagnosed with Prolactinoma ( 0,5 cm) 4 years ago. My Endo prescribed me Cabergoline 0,5 mg per week. From the very beginning I had strong side effects such as low blood pressure, fatigue, dizziness, depressive mood, abdominal pains and anxiety. Even after few months those side effects didn't get better, so my life was just no life anymore. Prolactin levels were after few weeks of Cabergoline normal, in the lower norm range. But I was forced to reduce the Cabergoline dosage, because I couldn't handle with the side effects. So I'm taking all the time only 0,25 mg Cabergoline in a week. The side effects are less now and my Prolactine level was till now only slightly over the norm range ( mostly between 20 and 25, the norm is 4-23). The MRI every year is without a change, the tumor is not getting bigger or smaller.
I have regular period all the time.
But in July 2011 I was diagnosed with a hypothyreoidism and my Prolactin level was much higher then usual: 40! Could it be because of the Hypothyroidism or it was my high prolactine who caused Hypothyroidism? I don't have Hashimoto, ( the Endo said, although my Thyroid has only 6 ml volume). I started with Thyroid hormons, 50 L-Thyroxine ( in Germany)
So my Endo suggested to increase Cabergoline too, on at least 0,5 mg pro week.
I have tried this few weeks ago, but I again feel depressed, have blood pressure problems, I'm sleepy all the time, having heavy nausea, and I have strong anxiety attacks, which are worse of all my symptoms. I'm wondering, if those anxiety symptoms are caused by high prolactine, or are they maybe some kind of worsening after taking thyroid meds? THS is now good, 1.4, but Ft3 and Ft4 are still in the lowest norm range.
I don't know what to do- I just can't live with the side effects of Cabergoline, but otherwise there is no hope that the tumor would shrink some day, right?
thank you!
I'm female, 46 years. Sorry for my bad english. I have been diagnosed with Prolactinoma ( 0,5 cm) 4 years ago. My Endo prescribed me Cabergoline 0,5 mg per week. From the very beginning I had strong side effects such as low blood pressure, fatigue, dizziness, depressive mood, abdominal pains and anxiety. Even after few months those side effects didn't get better, so my life was just no life anymore. Prolactin levels were after few weeks of Cabergoline normal, in the lower norm range. But I was forced to reduce the Cabergoline dosage, because I couldn't handle with the side effects. So I'm taking all the time only 0,25 mg Cabergoline in a week. The side effects are less now and my Prolactine level was till now only slightly over the norm range ( mostly between 20 and 25, the norm is 4-23). The MRI every year is without a change, the tumor is not getting bigger or smaller.
I have regular period all the time.
But in July 2011 I was diagnosed with a hypothyreoidism and my Prolactin level was much higher then usual: 40! Could it be because of the Hypothyroidism or it was my high prolactine who caused Hypothyroidism? I don't have Hashimoto, ( the Endo said, although my Thyroid has only 6 ml volume). I started with Thyroid hormons, 50 L-Thyroxine ( in Germany)
So my Endo suggested to increase Cabergoline too, on at least 0,5 mg pro week.
I have tried this few weeks ago, but I again feel depressed, have blood pressure problems, I'm sleepy all the time, having heavy nausea, and I have strong anxiety attacks, which are worse of all my symptoms. I'm wondering, if those anxiety symptoms are caused by high prolactine, or are they maybe some kind of worsening after taking thyroid meds? THS is now good, 1.4, but Ft3 and Ft4 are still in the lowest norm range.
I don't know what to do- I just can't live with the side effects of Cabergoline, but otherwise there is no hope that the tumor would shrink some day, right?
thank you!
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.
Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
Cabergoline is a dopamine agonist which can effectively suppress prolactin levels for about 2 weeks and can reduce the size of the prolactinoma in most patients (~70%). In about 5% of patients, the prolactinoma may resolve completely. However, some patients may need to have prolonged treatment or increase in dosage for treatment if the prolactinoma fails to respond or recurs. The medicine will need to be titrated to achieve maximal prolatin suppression. It is important to note that a normalized prolactin level does not ensure reduced tumor size. The usual dose may be increased every four weeks. And as you said, 1mg twice weekly is the stated maximum dose. Side effects to the medicine do occur and you should be aware of these. They include constipation, nasal stuffiness, dry mouth, nightmares, insomnia, and vertigo (dizziness). If your prolacintoma fails to respond to the maximum dose of cabergoline, you may need to discuss surgery with your oncologist.
One thing about prolactinomas is that you will need to be monitored closely for visual disturbance. Also, disorders of menses and fertility may occur with prolactinomas.
Hypothyroidism is a common disorder. The medications typically used to treat hypothyroidism can cause symptoms of anxiety/panic if the medication dose is too high or being titrated.
I would discuss your symptoms with your endocrinologist. You may need to have adjustments made or need to just wait and see.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
Cabergoline is a dopamine agonist which can effectively suppress prolactin levels for about 2 weeks and can reduce the size of the prolactinoma in most patients (~70%). In about 5% of patients, the prolactinoma may resolve completely. However, some patients may need to have prolonged treatment or increase in dosage for treatment if the prolactinoma fails to respond or recurs. The medicine will need to be titrated to achieve maximal prolatin suppression. It is important to note that a normalized prolactin level does not ensure reduced tumor size. The usual dose may be increased every four weeks. And as you said, 1mg twice weekly is the stated maximum dose. Side effects to the medicine do occur and you should be aware of these. They include constipation, nasal stuffiness, dry mouth, nightmares, insomnia, and vertigo (dizziness). If your prolacintoma fails to respond to the maximum dose of cabergoline, you may need to discuss surgery with your oncologist.
One thing about prolactinomas is that you will need to be monitored closely for visual disturbance. Also, disorders of menses and fertility may occur with prolactinomas.
Hypothyroidism is a common disorder. The medications typically used to treat hypothyroidism can cause symptoms of anxiety/panic if the medication dose is too high or being titrated.
I would discuss your symptoms with your endocrinologist. You may need to have adjustments made or need to just wait and see.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Sorry, wrong forum!!!!
A related discussion, Also have same issues with Cabergoline was started.
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