Vaginal cabergoline in the treatment of hyperprolactinemic patients intolerant to oral dopaminergics

Objective: To evaluate the effectiveness and tolerance of vaginal cabergoline in hyperprolactinemic patients intolerant to oral dopaminergics. Design: Case reports. Setting: University hospital endocrinological outpatient clinic. Patients: A 35-year-old primipara woman with idiopathic hyperprolactinemia and a 22-year-old female with primary amenorrhea harboring macroprolactinoma. Interventions: Treatment with vaginal cabergoline (0.5 mg two and five times a week). Main Outcome Measures: The serum PRL levels and side effects were assessed before and during treatment. Results: A single vaginal dose of 0.5 mg cabergoline reduced serum PRL levels by approximately 50% to 85% of basal values over a period of 4 to 5 hours. In the patient with idiopathic hyperprolactinemia, serum PRL levels normalized during long-term treatment, whereas in the one with macroprolactinoma they remained above the normal values (79 ng/mL [conversion factor to SI unit, 3.180]) despite resumption of menses and marked tumor shrinkage (70% reduction). No side effects were reported. Conclusions: Vaginal cabergoline is a safe and effective method of therapy for hyperprolactinemia and it avoids the adverse events of oral administration.