Cabergoline in the Treatment of Parkinson’s Disease

Cabergoline, an ergot dopamine agonist with a long elimination half-life, has been proved to be effective for treating Parkinson’s disease (PD) either as monotherapy in de novo patients or as an adjunct to levodopa therapy in patients with advanced PD. Typically, cabergoline is the second choice when patients do not respond adequately to other antiparkinsonian drugs. In the United States, cabergoline is recommended for the treatment of hyperprolactinemic disorders, either idiopathic or because of pituitary adenomas. Clinicians should be aware of the risk of fibrosis, especially of the heart valves. Perhaps, the underlying mechanism for the development of fibrosis is associated with the activation of serotonin receptor subtype 5-HT_2B. A meta-analysis reported that the risk of valvular regurgitation increased by 7.25 times in patients with PD taking cabergoline. Additionally, the mean cumulative dose of cabergoline was positively related to the odds ratio concerning valve regurgitation, although the possibility of developing valvular regurgitation is not excluded even with low dose of cabergoline. Thus, regular screening with echocardiography is imperative for the early detection of valvular dysfunction. Furthermore, chest X-rays, urine tests, and blood tests, including erythrocyte sedimentation rate and/or C-reactive protein, should be performed regularly. Currently, the recommended dose of cabergoline is up to 3 mg once daily.