Dawaa Reference

Clinical reference

Hyperprolactinaemia (Evaluation & Management)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

Endocrine Society Guideline on Pituitary Tumors 2011 · Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph)

Verified against3 documents
  • Endocrine Society Guideline on Pituitary Tumors 2011
  • Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph)
  • Hyperprolactinaemia (Evaluation & Management) - disease-level clinical article (hyperprolactinaemia-referral-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • A pituitary mass can present with headache along with visual field loss, blurred vision, or reduced visual acuity [blurred vision · headache]
  • Sudden bleeding into the tumor (pituitary apoplexy) causes severe headache, vision changes, and loss of pituitary hormone function, and is a medical emergency [bleeding · headache]
  • In men, reduced sex drive, impotence, erectile dysfunction, and low sperm count from secondary hypogonadism can occur [erectile dysfunction]
  • In women, irregular or absent periods, infertility, reduced libido, and spontaneous milky nipple discharge can occur [absent periods · infertility · nipple discharge]
  • In children, the condition can cause growth arrest, delayed puberty, and periods that never start
  • Bone thinning, anxiety, depression, fatigue, and mood instability were noted in both sexes [anxiety · fatigue · low mood]
  • About 10% of these tumors also secrete growth hormone, producing gigantism or acromegaly

Signs — what you find (2)

  • Cranial nerve palsy can occur, especially with an invasive tumor or sudden pituitary bleeding [bleeding · cranial nerve palsy]
  • Seizures, hydrocephalus, and swelling of one eye are described but are uncommon presentations [seizures]

Tests (1)

  • An eye specialist should formally chart the visual fields, especially when the tumor is a macroadenoma

If not this — what else fits (8)

  • Pregnancy, breastfeeding-related nipple stimulation, and stress are normal physiological causes of a raised prolactin level
  • Drugs that block dopamine - antipsychotics, tricyclics and SSRIs, antiemetics like metoclopramide or domperidone, verapamil or methyldopa, and opioids - can raise prolactin
  • An underactive thyroid gland or no identifiable cause (idiopathic) can explain a raised prolactin level
  • A non-prolactin-secreting pituitary adenoma can raise prolactin by pressing on the pituitary stalk
  • Hypothalamic disease, craniopharyngioma, meningioma, or dysgerminoma can also raise prolactin
  • Sarcoidosis, histiocytosis X, and prior cranial radiation are other recognized causes
  • Acromegaly, Cushing disease, empty sella syndrome, and lymphocytic hypophysitis are pituitary causes to rule out
  • Kidney failure and breast stimulation are also on the differential for a raised prolactin

SourceStatPearls "Prolactinoma" - disease-level clinical article

Presentation findings are traced to the source above.

1

CABERGOLINE

1st line

Strength0.5 mg

Formoral.solid

Adult dose and duration

0.5 mg weekly (administered as 0.25 mg twice weekly), titrate by 0.5 mg/week monthly up to max 4.5 mg/week based on prolactin levels - long-term

Paediatric dose

Specialist pediatric endocrinology management

Dose source

Endocrine Society Guideline on Pituitary Tumors 2011

Why

Dopamine agonist that suppresses prolactin secretion by stimulating pituitary D2 receptors; first-line therapy for hyperprolactinaemia given its efficacy and tolerability advantage over bromocriptine, started only after pregnancy, hypothyroidism, and drug-induced causes have been excluded.

Cautions
  • Cabergoline is the first-line dopamine agonist, with superior efficacy and tolerability over bromocriptine.
  • Exclude pregnancy, hypothyroidism, and drug-induced causes (antipsychotics, metoclopramide) before starting.
  • Perform baseline echocardiogram if high doses (>2 mg/week) or prolonged high-dose therapy are used due to risk of cardiac valvulopathy.
Egyptian brands
Egyptian brandManufacturerIndicative price
CABERGOLACTO 0.5 MG 2 TABS.IDI > NOVELL PHARMA36.00 EGP (18.00/unit)
CABERGLOBE 0.5 MG 2 TABS.EGPI > GLOBE INTERNATIONAL PHARMACEUTICALS45.00 EGP (22.50/unit)
MARVIGOLINE 0.5 MG 2 TABS.RAMEDA66.00 EGP (33.00/unit)
CABROSTINEX 0.5 MG 8 TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES > ROTABIOGEN339.00 EGP (42.38/unit)
GOLINOTECH 0.5 MG 2 TABS.EUROPEAN EGYPTIAN PHARM. IND. > PHARMA-TECH103.00 EGP (51.50/unit)
DOSTILACT 0.5 MG 2 TABS.ATCO PHARMA > OMEGA PHARMA OPCI105.00 EGP (52.50/unit)
DOSTINEX 0.5 MG 2 TABS.PFIZER172.00 EGP (86.00/unit)
DELCABRIN 0.5 MG 2 SCORED TABS.EGPI > HEALTH WELL EGYPT105.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Hyperprolactinaemia (Evaluation & Management) - disease-level clinical article (hyperprolactinaemia-referral-full.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Pituitary apoplexy is an endocrine emergency presenting with sudden headache and visual disturbances, requiring urgent MRI and neurosurgical evaluation.
3

BROMOCRIPTINE

2nd line

Strength2.5 mg

Formoral.solid

Adult dose and duration

1.25 mg at bedtime with food, titrate to 2.5 mg twice to three times daily - long-term

Paediatric dose

Specialist use only

Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (bromocriptine monograph)

Why

Older dopamine agonist with the same prolactin-suppressing mechanism as cabergoline, preferred specifically when pregnancy is desired because of its longer safety track record in that setting.

Cautions
  • Bromocriptine is the preferred dopamine agonist if pregnancy is desired, due to its extensive safety history.
  • Nausea, postural hypotension, and dizziness are common during dose initiation.
Egyptian brands
Egyptian brandManufacturerIndicative price
PARLODEL 2.5MG 20 TAB.NOVARTIS27.60 EGP (1.38/unit)
BROMOCRIPTINE 2.5 MG 30 TAB.OCTOBER PHARMA66.00 EGP (2.20/unit)
LACTODEL 2.5MG 20 TAB.AMOUN72.00 EGP (3.60/unit)
DOPAGON 2.5MG 20 TAB.MEMPHIS94.00 EGP (4.70/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.