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Clinical pharmacokinetics of cabergoline.

Cabergoline is a synthetic ergoline dopamine agonist with a high affinity
for D(2) receptors indicated for use in both early and advanced Parkinson's
disease and in hyperprolactinaemic disorders. Following oral
administration, peak plasma concentrations of cabergoline are reached
within 2-3 hours. Over the 0.5-7mg dose range, cabergoline shows linear
pharmacokinetics in healthy adult volunteers and parkinsonian patients.

Cabergoline is moderately bound (around 40%) to human plasma proteins in a
concentration-independent manner; concomitant administration of highly
protein-bound drugs is unlikely to affect its disposition. The absolute
bioavailability of cabergoline is unknown. Cabergoline is extensively
metabolised by the liver, predominantly via hydrolysis of the acylurea bond
of the urea moiety. Cytochrome P450-mediated metabolism appears to be
minimal. The major metabolites identified thus far do not contribute to the
therapeutic effect of cabergoline. A significant fraction of the
administered dose undergoes a first-pass effect. Less than 4% is excreted
unchanged in the urine. The elimination half-life of cabergoline estimated
from urinary data of healthy subjects ranges between 63 and 109 hours. Mild
to moderate renal and hepatic impairment, administration of food and the
use of concomitant antiparkinsonian medications, such as levodopa and
selegiline, have no effect on the pharmacokinetics of cabergoline.

The pharmacokinetic properties of cabergoline allow once daily
administration in patients with Parkinson's disease and twice weekly
administration in patients with hyperprolactinaemia, making this drug
advantageous over other dopaminergic agents in term of both therapeutic
compliance and better symptom control.

Clin Pharmacokinet. 2003;42(7):633-45.
Del Dotto P, Bonuccelli U.
Movement Disorders Unit, University of Pisa, Pisa, Italy.
PMID: 12844325

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