Dostinex contains cabergoline, a dopamine agonist. It is prescribed to lower prolactin — a hormone that, when raised, causes irregular or absent periods, milk production, infertility and reduced sex drive. It is also used to stop breast milk production, and in some cases of Parkinson’s disease. It is taken weekly rather than daily.
What is Dostinex?
Dostinex is Schedule 4 in South Africa — prescription-only — and contains cabergoline, commonly as 0.5 mg tablets.
Cabergoline is a dopamine agonist. It stimulates dopamine D2 receptors, and the reason that lowers prolactin is worth understanding, because it is unusual.
Most hormones are controlled by a signal telling the gland to produce more. Prolactin is different: the pituitary gland produces it continuously, and dopamine from the brain acts as a constant brake. Cabergoline mimics dopamine, pressing that brake harder — so prolactin production falls.
This also explains a common cause of raised prolactin. Medicines that block dopamine — particularly antipsychotics such as risperidone, and anti-nausea medicines such as metoclopramide — release the brake, and prolactin rises. If your prolactin is high, the first question is often which medicines you take, not whether you need cabergoline.
Cabergoline’s very long duration is its practical distinguishing feature. It is taken once or twice weekly, not daily — which is easily misunderstood and worth confirming on your prescription. Taking it daily by mistake is a genuine risk.
What is Dostinex commonly used for?
- Hyperprolactinaemia — raised prolactin — from any cause. The main use.
- Prolactinoma, a benign pituitary tumour producing prolactin. Cabergoline often shrinks these substantially, and medicine has largely replaced surgery as first-line treatment.
- Suppressing lactation, stopping breast milk production after birth — including after stillbirth or neonatal death, or where breastfeeding is not possible.
- Infertility caused by raised prolactin, where lowering it restores ovulation.
- Irregular or absent periods caused by raised prolactin.
- Parkinson’s disease, as an add-on, though other dopamine agonists are now generally preferred.
Raised prolactin produces a recognisable pattern: irregular or absent periods, milk production unrelated to breastfeeding (galactorrhoea), infertility, reduced sex drive, and in men erectile difficulty and breast enlargement. Long-standing untreated hyperprolactinaemia also reduces bone density.
It treats the prolactin, and sometimes the tumour, rather than every underlying cause. Where a medicine is responsible, changing that medicine may be the better answer.
How Dostinex fits into this medicine category
| Group | Examples | Role |
|---|---|---|
| Dopamine agonists | Cabergoline (Dostinex), bromocriptine | Lower prolactin; Parkinson’s disease |
| Progestogens | Dydrogesterone, norethisterone | Cycle control, heavy bleeding |
| Combined contraceptives | Oestrogen + progestogen | Contraception, cycle regulation |
| Antipsychotics | Risperidone | Can raise prolactin — a common cause |
| Anti-nausea | Metoclopramide, prochlorperazine | Can raise prolactin |
| Thyroid medicines | Levothyroxine | An underactive thyroid also raises prolactin |
Cabergoline is generally preferred over bromocriptine, being more effective, better tolerated and taken far less often. See the general medicines hub and the HP553 guide.
What to check before using Dostinex
Confirm how often to take it. Cabergoline is usually weekly or twice weekly. Check your prescription, and ask the pharmacist if the instructions are unclear — this is the single most important practical check with this medicine.
Take it with food, which reduces nausea, and often at bedtime to limit dizziness.
Fertility can return quickly. Lowering prolactin frequently restores ovulation — often before periods become regular again, so pregnancy can occur sooner than expected. If you do not want to become pregnant, use contraception, and discuss plans with your doctor if you do.
Tell your doctor or pharmacist if you:
- Have heart valve disease, or a heart murmur. Cabergoline has been associated with valve thickening (fibrosis) at the higher doses used in Parkinson’s disease. An echocardiogram is usually done before starting and periodically afterwards, particularly on long-term or higher-dose treatment.
- Have lung, kidney or abdominal fibrosis, or a history of it.
- Have high blood pressure, particularly after childbirth.
- Have liver disease.
- Have low blood pressure, or faint easily.
- Have a history of psychiatric illness, or impulse-control problems.
- Have Raynaud’s, or a stomach ulcer.
- Are pregnant, planning pregnancy or breastfeeding.
- Take antipsychotics or metoclopramide, which oppose its effect and may themselves be the cause of raised prolactin.
- Take blood pressure medicines, or macrolide antibiotics such as erythromycin, which raise cabergoline levels.
Expect monitoring — prolactin levels, and imaging if a pituitary tumour is being treated.
Possible cautions and when to ask a pharmacist or doctor
Common effects are nausea, headache, dizziness — especially standing up — tiredness, abdominal pain and constipation. These are usually worst when starting and often settle. Starting at a low dose and taking it with food at bedtime helps considerably.
Seek medical attention if you develop:
- Breathlessness, a persistent cough, chest pain, or swollen ankles — possible heart valve or lung fibrosis. Report these promptly.
- Sudden severe headache, visual disturbance or vomiting — particularly if you have a pituitary tumour.
- Fainting, or severe dizziness.
- New or unusual impulsive behaviour — compulsive gambling, shopping, eating or sexual behaviour. This is a recognised effect of dopamine agonists, can develop without the person recognising it as out of character, and is often noticed first by family. It resolves when the medicine is reduced or stopped — but it must be reported.
- Hallucinations, confusion or unusual dreams.
- Sudden onset of sleep, or excessive daytime sleepiness. Do not drive if this occurs.
- Persistent abdominal or back pain.
- Swelling of the face, lips or tongue, or a rash.
In women who have recently given birth, seek urgent attention for severe headache, seizures, chest pain or a marked rise in blood pressure.
Contact your doctor if periods do not return, if milk production continues, if you become pregnant, or if symptoms of raised prolactin persist despite treatment.
Related medicine guides
Frequently asked questions
What is Dostinex used for? Lowering raised prolactin — which causes irregular or absent periods, milk production, infertility and reduced sex drive — and shrinking prolactin-producing pituitary tumours. It is also used to stop breast milk production.
How often do I take it? Usually once or twice weekly, not daily. Confirm the instructions on your prescription, and ask a pharmacist if unclear.
Will it help me get pregnant? Where infertility is caused by raised prolactin, lowering it often restores ovulation. Fertility can return before periods become regular.
Can it stop breast milk? Yes — suppressing lactation is an established use, including after stillbirth or where breastfeeding is not possible.
Why has my prolactin gone up? Common causes include a pituitary tumour, an underactive thyroid, pregnancy, and medicines that block dopamine such as antipsychotics and metoclopramide.
Does it need heart monitoring? Cabergoline has been associated with heart valve thickening, mainly at higher doses. An echocardiogram is usually done before starting and periodically afterwards.
What are impulse-control problems? Compulsive gambling, shopping, eating or sexual behaviour — a recognised effect of dopamine agonists, often noticed by family first. Report it; it resolves on reducing or stopping.
Can I take it in pregnancy? Discuss it with your doctor. It is usually stopped once pregnancy is confirmed, but that is a medical decision.