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Dostinex is a specialist drug whose task is to prevent lactation after childbirth or to inhibit lactation that has already started. Read how to take Dostinex, what are the indications, side effects and precautions.
Dostinex – what kind of drug is it?
Dostinex is a drug that is used to suppress lactation, disorders related to the excessive secretion of prolactin (hyperprolactinaemia), including menstrual disorders (amenorrhea, scanty or irregular periods), anovulation, galactorrhea and the treatment of pituitary adenoma, idiopathic hyperprolactinaemia or Empty Turkish Saddle Syndrome associated with hyperprolactinemia.
The drug Dostinex is a derivative of ergoline with dopaminergic activity, strongly and long-term lowering the concentration of prolactin. It works by directly stimulating dopamine D2 receptors in the cells of the anterior pituitary gland, thereby inhibiting the secretion of prolactin.
The active substance of Dostinex is cabergoline. The other ingredients are: leucine, anhydrous lactose.
Also read: Lactation – stages and composition of milk, home methods. How to stimulate and stop lactation?
Dostinex – dosage
Cabergoline is intended for oral use. The dopaminergic products are better tolerated when taken simultaneously with foodtherefore it is recommended to use cabergoline with meals.
In the case of people intolerant to dopaminergic products, the likelihood of side effects can be reduced by starting treatment with a reduced dose of the drug (e.g. 0,25 mg once a week) and gradually increasing the dose until the therapeutic dose is reached.
In the event of persistent or severe side effects, the tolerance of the product can be increased by periodically reducing the dose and then returning to the therapeutic dose by gradually increasing it (e.g. 0,25 mg weekly, every two weeks).
The maximum daily dose of Dostinex is 3 mg.
Dosage of the drug Dostinex in the case of inhibition of lactation:
- 1 mg of cabergoline (2 tablets of 0,5 mg) in one dose on the first day after delivery,
Dosage of Dostinex in case of stopping milk secretion:
- 0,25 mg (half a tablet) should be administered every 12 hours for two days,
Dosage of Dostinex in the treatment of disorders related to the excessive secretion of prolactin:
- the recommended starting dose is 0,5 mg per week given as one (1 tablet 0,5 mg) or two doses (half a tablet twice a week, e.g. on Monday and Thursday).
The weekly dose should be increased gradually, preferably by 0,5 mg per week, at monthly intervals, until the optimal therapeutic effect is achieved. The therapeutic dose ranges from 0,25 mg to 2 mg per week, with an average of 1 mg per week. Doses of up to 4,5 mg per week have been used in patients with hyperprolactinaemia.
The weekly dose can be administered at one time or divided into two or more portions depending on the tolerance of the product. Dividing the weekly dose into several portions is recommended when the weekly dose is greater than 1 mg.
Persons taking Dostinex should be monitored during the period of increasing the dose in order to establish the lowest effective dose at which the therapeutic effect is achieved. After the therapeutic dose is established, the prolactin concentration in the blood should be monitored at monthly intervals. Normalization of prolactin levels is usually achieved within 2-4 weeks.
After discontinuation of cabergoline therapy, recurrence of hyperprolactinaemia is usually observed. However, some people have seen sustained reductions in prolactin levels over many months. Most women have had ovulatory cycles for at least 6 months after cabergoline was stopped.
Dosage of Dostinex for people with severe liver failure:
- in people with severe hepatic insufficiency, consideration should be given to reducing the dose of Dostinex,
Dosage of Dostinex for children and adolescents:
- the safety and efficacy of the product has not been assessed in people younger than 16 years of age,
Dosage of Dostinex for the elderly:
- The use of cabergoline in elderly patients with disorders related to the excessive secretion of prolactin has not been regularly studied.
See: How to check if the cycles are ovulatory?
Dostinex – contraindications
Dostinex cannot be used in cases of hypersensitivity to cabergoline or to any of the excipients and other ergot derivatives (eg Adavin, Nilogrin, Sermion, Ergotaminum, Dihydroergotoxinum). All ingredients are listed on the leaflet included in the package of Dostinex tablets.
Taking this drug is excluded in the case of previously diagnosed fibrosis of the lung, pericardium and retroperitoneal space, as well as peptic ulcer disease. Due to the lactose content, the preparation should not be used in patients with galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose.
Before starting treatment with Dostinex, it is recommended to perform echocardiography – detection of a valvular heart disease excludes the use of this drug.
You cannot take Dostinex when you are taking macrolide antibiotics, medications to lower blood pressure, drugs that are phenothiazines, and also ergot alacoids.
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Dostinex – precautions
Caution should be exercised when using the drug Dostinex, which contains cabergoline, in people with severe cardiovascular disorders, Raynaud’s syndrome, peptic ulcer or gastrointestinal bleeding, and in patients with a history of serious mental disorders, in particular psychoses.
In people with severe hepatic insufficiency, lower doses should be considered in the case of chronic use of cabergoline.
Postural hypotension may occur following administration of cabergoline. Take special care when taking cabergoline together with other drugs that lower blood pressure.
The use of cabergoline has been associated with somnolence. The use of dopamine agonists may be associated with sudden sleep attacks in patients with Parkinson’s disease. In this case, consideration may be given to reducing the dose of the drug or stopping treatment.
Like other ergotamine derivatives, cabergoline should not be used in women with pregnancy-induced hypertension, pre-eclampsia or postpartum hypertension, unless the potential benefits outweigh the risks. To avoid orthostatic hypotension, a single dose of 0,25 mg cabergoline should not be exceeded to suppress ongoing lactation in lactating women.
Serious adverse events including hypertension, myocardial infarction, convulsions, stroke and psychiatric disorders have been reported in postpartum women using cabergoline to suppress lactation. In some women, seizures or stroke were preceded by severe headache and / or temporary visual disturbances. Blood pressure should be carefully monitored during treatment. If a patient develops hypertension, characteristic chest pain, severe, progressive or persistent headache (with or without visual disturbances) or signs of central nervous system toxicity, cabergoline should be discontinued and the patient should be promptly evaluated.
Particular precautions should also be taken:
- in the case of concomitant use of drugs lowering blood pressure, as postural hypotension may occur after administration of cabergoline (especially in the first days of treatment),
- in people who have symptoms of respiratory or cardiovascular disorders associated with the process of fibrosis or with a history of such disorders,
- People with Parkinson’s disease may experience episodes of suddenly falling asleep – dose reduction or treatment discontinuation should be considered.
- if you have or have had a history of fibrosis (scarring) reactions in the heart muscle, lungs or abdominal organs. If you are taking Dostinex for a long time, your doctor will check the function of your heart, lungs and kidneys before starting treatment. Echocardiography (ultrasound – ultrasound of the heart) will be performed before starting treatment, and at regular intervals during treatment. Treatment will be stopped if a fibrotic reaction occurs.
- tell the doctor if the patient or his relatives notice unusual behavior resulting from an irresistible impulse, compulsion, compulsive performance of certain activities, harmful to the patient or other people. These behaviors are called impulse control disorders and can include gambling addiction, binge eating or compulsions, excess sexual drive, or increased sexual thoughts and feelings. Your doctor may decide to adjust your treatment or stop the drug.
Because Dostinex restores ovulation and fertility in women with hypogonadism associated with hyperprolactinaemia. It is recommended that you have a pregnancy test at least every 4 weeks before your period starts and thereafter whenever there is a delay of more than 3 days. Women who wish to avoid pregnancy should use barrier contraception during treatment with Dostinex and after discontinuation of treatment, until ovulation fails again.
Women who become pregnant should be watched for signs of pituitary enlargement as pre-existing pituitary tumors may grow during pregnancy.
Read also: Contraceptive pills and thrombosis. What’s the risk? Explains the gynecologist
Dostinex, pregnancy and breastfeeding
If a woman is pregnant or breastfeeding, thinks she may be pregnant or is planning to have a baby, she should ask her doctor or pharmacist for advice before taking this medicine. Pregnancy should be excluded before starting the administration of Dostinex.
In addition, measures should be taken to prevent becoming pregnant for at least one month after stopping treatment with Dostinex. There are no clinical data on the use of Dostinex in pregnant women. Animal studies have shown reduced fertility and possible fetal toxicity. Dostinex should only be used during pregnancy if clearly indicated and after careful risk-benefit assessment.
Due to the long half-life of the drug and limited data on fetal exposure, women planning pregnancy should discontinue Dostinex one month before conception. If conception occurs during therapy, treatment should be discontinued as soon as pregnancy is confirmed in order to reduce exposure of the fetus to the drug. Taking into account the mechanism of action of the drug Dostinex, it should be expected to inhibit or limit lactation during its use. Women taking Dostinex must not breastfeed.
See: Breastfeeding reduces the risk of childhood leukemia
Dostinex – side effects
The side effects observed as a result of the action of Dostinex are very common: valvular heart disease (including reflux wave) and related disorders (pericarditis, pericardial effusion). Common: orthostatic hypotension. Uncommon: vascular spasm of the fingers, syncope, cramps in the muscles of the lower limbs, pruritus, in amenorrhoeic women decreased hemoglobin levels during the first few months after resumption of menstruation, increased libido, dyspnoea, alopecia, rash, edema. Rare: muscle fatigue and / or fatigue, allergic skin reactions. Very rare: Pulmonary fibrosis.
While taking Dostinex, you should not drive or operate machinery.
Dostinex – overdose
Symptoms of overdose are presumed to be those related to overstimulation of dopamine receptors, e.g. nausea, vomiting, stomach discomfort, postural hypotension, confusion and / or psychosis or hallucinations. If necessary, use methods to support the removal of unabsorbed drug and maintain stable blood pressure values. Additionally, it may be appropriate to administer dopamine antagonists.
Dostinex – additional information
Dostinex is one of the more expensive drugs, but there are no substitutes. The price for Dostinex depends on the contents of the package – packages containing two, five and eight tablets are available.