Mg Of Cabergoline Research Articles

Effects of feed energy density, daily milking frequency, and a single injection of cabergoline on behavior and welfare in dairy cows at dry-off

Drying off dairy cows may challenge animal welfare due to high milk yields. A total of 111 loose-housed Holstein cows yielding >15 kg/d of milk were included in a 2 × 2 × 2 factorial design during dry-off to investigate the effects of reduced feeding level (normal vs. reduced energy density), reduced milking frequency (twice vs. once daily), and administration of a dopamine agonist (saline i.m. injection vs. cabergoline i.m. injection) on behavior in the home pen. During the 7 d before dry-off, cows were fed and milked according to 1 of the 4 feeding level and milking frequency combinations. Within 3 h after the last milking, cows were injected i.m. with 5 mL of either saline or a dopamine agonist (5.6 mg of cabergoline; Velactis, Ceva Santé Animale, Libourne, France; labeled for use only with abrupt dry-off, i.e., no preceding reduction in feeding level or milking frequency before last milking). Cows' behavior during d -1, 0, and +1 relative to the last milking was recorded via video and leg-attached sensors. Cows on the reduced energy density diet spent more time feeding and showed more attempts to feed from other cows' bins on d -1. Throughout the period of observations, cows on the reduced diet spent a lower percentage of lying time with their head raised, a higher percentage of lying time with their legs bent, and less time standing in a vigilant posture than did cows on the normal lactation diet. Reducing the daily milking frequency from 2 to 1 did not result in any clear behavioral signs of discomfort. On d 0, cows injected with cabergoline lay down longer but had their head raised for a shorter percentage of time while lying, compared with cows injected with saline. Cows injected with cabergoline also spent less time feeding than cows injected with saline on d 0, and reduced the time spent drinking from d -1 to d 0. Finally, fewer cabergoline-injected cows used the brush for self-grooming, and, among cows that did use the brush, the cows injected with cabergoline reduced the time spent using the brush from d -1 to d 0. In conclusion, cows injected with cabergoline showed several behavioral changes compared with control cows injected with saline. The behavioral changes shown by cows injected with cabergoline may be indicative of malaise during the first 24 h after injection, raising concern for animal welfare. No behavioral evidence for reduced udder pain in cows injected with cabergoline compared with control cows injected with saline was found. Drying off by reducing the energy density of the diet caused behavioral changes indicative of hunger before dry-off, whereas reducing the milking frequency had no clear effects on behavior.

Abstract #1395486: Uncontrolled Acromegaly Resulting in the Need for LVAD as Bridge to Heart Transplant

Acromegaly is an uncommon pituitary disorder with an incidence of six per million persons. While hypertension is often encountered in these patients, heart failure rarely is seen with an incidence rate under 10%. We describe a case of an individual who was diagnosed with acromegaly after an acute exacerbation of heart failure with subsequent management requiring an LVAD to perform Transsphenoidal Surgery (TSS). 37-year-old male otherwise healthy initially presented to an emergency room and was found to be in acute heart failure exacerbation. Concerning acromegaly features included macrognathia, enlarged hands and feet, swollen phalanges, widened spacing of teeth, and frontal bossing. IGF-1 level was found 455 ng/mL. MRI showed a 10mm macroadenoma. A right heart catheterization showed elevated filling pressures. Cardiac MRI showed no defects or enhancement. Endomyocardial biopsy showed no inflammatory infiltrates or evidence of infiltrative diseases. Patient had an ejection fraction of 15% corroborated by cardiac MRI along with the presence of aortic root dilatation and mitral regurgitation. The patient started on 0.5mg of Cabergoline twice weekly and 120mg weekly Lanreotide injections. Patient stabilized with plans for further close monitoring and outpatient neurosurgical evaluation. The COVID-19 pandemic and insurance gaps led the patient to spend two years off his medicines and he was unable to be seen by his medical team. Patient was seen by our system after recurrent hospitalizations for heart failure at our sister hospital, AICD was unable to be placed due to the patient’s anatomy, he was placed on wearable cardiac defibrillator and required milrinone infusion for progression to end-stage heart failure with cardiac cachexia. At our institution, the patient was evaluated for Orthotopic Heart Transplant (OHT) but due to active GH secreting macroadenoma there was concern for OHT failure without TSS. Decision was made to utilize LVAD as Bridge-to-Transplant for OHT so the patient could be stabilized and safely undergo TSS. The patient tolerated surgeries well and is currently on the active transplant list. Heart failure is an uncommon presentation of severe acromegaly requiring multidisciplinary management. We describe a case of a patient who initially presented with heart failure too unstable for surgery. Due to the COVID-19 pandemic the patient’s disease progressed resulting in end-stage heart failure requiring LVAD placement for further treatment. We would like to draw attention to the use of LVAD placement in acromegalic patients who develop severe cardiovascular disease who are not candidates for OHT.

Calcium gluconate infusion is not as effective as dopamine agonists in preventing ovarian hyperstimulation syndrome.

The aim of the study was to compare the effectiveness of calcium gluconate and cabergoline therapy in the prevention of ovarian hyperstimulation syndrome (OHSS). Eight hundred and forty-five women who underwent GnRH antagonist protocol and at high risk for developing OHSS were divided into two groups, those given cabergoline (n=435) or calcium gluconate (n=410). In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. starting on the day of ovulation trigger and continued until the following 8 days. In calcium gluconate group, intravenous calcium gluconate was administered daily for four days starting on the day of oocyte pickup (OPU). 10 ml of 10% calcium gluconate solution was dissolved in 200 ml of physiological saline and administered by intravenous route within 40 minutes. Infusion was started within the first 30 minutes following the OPU and continued on the 1st, 2nd and 3rd days after OPU. Mild OHSS was developed in 367 (89%) patients receiving calcium gluconate infusion, while 251 patients (57%) in the cabergoline group developed mild OHSS. The frequency of mild OHSS in the calcium group was significantly higher than the cabergoline group (p<.001). Moderate OHSS was observed in 32 people (7.8%) in the calcium gluconate group, while it was observed in 184 people in the cabergoline group (42.3%). Calcium gluconate infusion significantly reduced the development of moderate OHSS compared to cabergoline therapy (p<.001). Severe OHSS developed in 11 patients (2.7%) in the calcium gluconate group, while severe OHSS did not develop in those given cabergoline (0%, p<.001). Clinical pregnancy, live birth and abortion rates were similar in the two groups. When logistic regression analysis was performed, a significant correlation was found between age, BMI, AMH, the number of antral follicle count, OHSS history, paracentesis, progesterone on the day of hCG, 2 PN zygotes, and HbA1c levels and the development of OHSS. No correlation was found between the use of metformin or cetrotide and the development of OHSS. Calcium gluconate treatment is not effective in the prevention of OHSS.

INNOVATIVE CONTROLLED OVARIAN STIMULATION (COS) METHOD FOR SEVERE POLYCYSTIC OVARY SYNDROME (PCOS) WITHOUT OVARIAN HYPERSTIMULATION SYNDROME (OHSS) AND HIGHER OOCYTE QUALITY

We developed an innovative controlled ovarian stimulation method for severe PCOS cases without OHSS, higher oocyte quality and optimal number of oocytes using an aromatase inhibitor (Letrozole). Twenty-five severe PCOS patients who had over 20 antral follicles in both ovaries, over 10 mg/ml of anti-Mullerian hormone (AMH) and had been hospitalized due to severe OHSS participated in this study. From the third day of the period, 5mg of Letrozole and 150iu of FSH/HMG were administered every day until the day of trigger administration. When the leading follicle reached 18mm in diameter, the injection of 0.25mg of GnRH antagonist started and continued until the day of the trigger shot. Estradiol (E2), luteinizing hormone (LH) and progesterone (P) were measured every day. After confirmation that the largest follicle was 22-24 mm in diameter and E2 level was less than 500-700pg/ml , 5000iu of HCG was administered as trigger and oocyte collection was performed 37 hours later under general anesthesia with Propofol. All embryos were cryopreserved after IVF or ICSI. 2.5mg of Letrozole, 0.5mg of Cabergoline and 0.25mg of GnRH antagonist were administered just after the oocyte retrieval for five days consecutively. The levels of vessel endothelial growth factor (VEGF)of all patients were examined carefully and then the patients discharged. All of them were re-examined after 3-4 days. Characteristics of this COS are shown in Table.TableCharacteristics of new COS methodn=25Age at OPU(y)33.1±2.4AMH(ng/mL)13.2±3.1Peak E2(pg/mL)624.3±311.2AFC38.1±15.2Peak follicle size(mm)24.2±3.1No. of days stimulated10.0±2.3No. of retrieved oocytes15.7±6.3Matured (M2) oocytes (%)83.3 (250/300)MI oocytes (%)4.0(12/300)GV oocytes (%)11.3(34/300)Degenerated oocytes (%)1.3(4/300)No. of frozen embryos4.3±2.1level of VEGF (pg/ml)56.7±23.1Days between oocyte collection and withdrawal hemorrhage5.4±2.4 Open table in a new tab This newly developed controlled ovarian stimulation with consecutively used Letrozole for severe PCOS cases seems to be a possible first line treatment for severe PCOS though no clinical data is available yet.

Cabergoline versus calcium infusion in the prevention of ovarian hyperstimulation syndrome: a randomised controlled study

The aim of this study was to compare the efficacy of calcium infusion versus cabergoline in the prevention of ovarian hyperstimulation syndrome (OHSS) in IVF patients at high risk for OHSS. One hundred and seventy patients who were stimulated using the long luteal GnRH agonist protocol and at high risk for developing OHSS were randomised in a 1:1 ratio to cabergoline group and calcium gluconate group. In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. for eight days starting on the day of HCG administration. In calcium gluconate group, intravenous calcium gluconate (10%, 10 ml in 200 ml of physiologic saline) was administered daily for four days starting on the day of ovum pickup. Six patients in cabergoline group and eight patients in calcium gluconate group developed moderate OHSS. One patient in each group developed severe OHSS. The incidence of moderate/severe OHSS was comparable between both groups (8.24% vs. 10.59%, p value = .599, OR = 0.76, 95% CI [0.269–2.138]). The implantation, clinical and ongoing pregnancy rates were similar in the two groups (16.91% vs. 15.84%, p = .771, 35.29% vs. 32.94%, p = .746, and 30.59% vs. 28.24%, p = .736, respectively). In conclusion, calcium infusion and cabergoline have comparable effectiveness in the prevention of OHSS. Both drugs are well tolerated, cheap and have no adverse effects on the reproductive outcomes of IVF cycle. Clinical trial registration: The trial was registered on clinical trials.gov database [NCT02875587]. Impact Statement What is already known on this subject? The effectiveness of cabergoline in the prevention of OHSS in IVF patients at high risk for OHSS is confirmed by overwhelming scientific evidence. Calcium infusion is a novel strategy for prevention of OHSS. Few studies reported the use of calcium infusion in the prevention of OHSS. A retrospective study and a randomised controlled study revealed that calcium infusion reduces the incidence of OHSS. Moreover, a quasi-randomised study revealed that calcium infusion is as effective as cabergoline in the prevention of OHSS. What the results of this study add? Calcium infusion and cabergoline have comparable effectiveness in the prevention of OHSS. Both drugs are well tolerated, cheap and have no adverse effects on the reproductive outcomes of IVF cycle. What the implications are of these findings for clinical practice and/or further research? Calcium infusion should be used to minimise the incidence of OHSS in IVF patients at high risk for OHSS.

Current possibilities in the prevention and therapy of ovarian hyperstimulation syndrome.

To present current possibilities of the prevention and therapy of ovarian hyperstimulation syndrome (OHSS). Literature and guidelines were researched. From the view of safety and prevention of OHSS, antagonistic protocol is suitable. Patients with syndrome of polycystic ovaries benefit from the use of metformin or letrozole that can be sufficient to induce ovulation. As atreatment of imminent OHSS, it is recommended to administer 0.5 mg of cabergoline per os daily as well as low molecular weight heparin subcutaneously in prophylactic dose and to maintain sufficient fluid intake. Diuretics are strongly discouraged to use. To maintain intravascular volume, drained ascites can be reintroduced. We present areview of current literature and recommendations.

Is Cabergoline Safe and Effective for Postpartum Lactation Inhibition? A Systematic Review.

BackgroundDespite its benefits, there are some situations where breastfeeding is impossible or not recommended. Breast milk secretion and engorgement can be distressing to these non-breastfeeding women. There is currently no universal guideline on the most appropriate management for these women. Our objective is to evaluate the effectiveness and safety of cabergoline, a dopamine agonist, in lactation inhibition in postpartum women.MethodsStudies were identified through electronic database searching (Cochrane library, EMBASE, Medline, IPA and Scopus) to identify all relevant studies that evaluated the use of cabergoline as a lactation inhibitor in postpartum women. Citations were screened and a narrative synthesis was undertaken given the heterogeneity of study designs.ResultsA total of six randomized trials met the inclusion criteria. Majority of the studies recruited healthy postpartum women electing for lactation inhibition for personal reasons. A range of 0.4 mg to 1 mg of cabergoline was given within 0 to 50 hrs of delivery. Dose–response relationship is established, and the highest rate of complete success was achieved with 1 mg of cabergoline, with time to cessation between 0 and 1 day. Cabergoline is non-inferior to bromocriptine for lactation inhibition while also associated with fewer rebound symptoms and adverse effects. Commonly reported adverse effects of cabergoline (eg, dizziness, headache and nausea) are self-limited.ConclusionCabergoline is simple, effective and generally safe when given to postpartum women either wishing or needing to suppress lactation. Further research is needed to improve postpartum care of these women.

Efficacy of cabergoline in a double-blind randomized clinical trial on milk leakage reduction at drying-off and new intramammary infections across the dry period and postcalving

The abrupt cessation of milking at dry-off may induce milk leakage, which may increase the risk of new intramammary infections (IMI). This study assessed the efficacy of 1 i.m. injection of 5.6 mg of cabergoline (Velactis, Ceva Santé Animale, Libourne, France) at drying-off on milk leakage after dry-off and new IMI across the dry period and postcalving compared with a placebo (negative control) and an intramammary antibiotic treatment (positive control) under field conditions. The study was a double-blind, randomized, 3-arm, multicenter, clinical trial performed under Good Clinical Practice conditions. Data from 900 dairy cows of various breeds from 63 farms in France, Germany, and Hungary were analyzed. Only quarters with no bacterial growth at drying-off and a cow somatic cell count ≤200,000 cells/mL were included. Quarters infected with major or minor pathogens or cows with high somatic cell count at time of inclusion were excluded. Cows that qualified for the study were visited 7 times in total before and after drying-off and after calving. Presence (yes/no) of milk leakage was recorded on the day after dry-off. A new infected quarter (new IMI) was defined as one with a major pathogen present in any one of the 2 postcalving samples. Two mixed logistic regression models were fitted to the data to evaluate the efficacy of cabergoline in the reduction of milk leakage and new IMI. One i.m. injection of cabergoline at drying-off significantly reduced the incidence of milk leakage the day after dry-off compared with both placebo and antibiotic treatment. Cabergoline-treated cows significantly reduced the risk of new IMI by major pathogens across the dry period and postcalving by 21% when compared with placebo cows (20.5 vs. 26.0%, respectively). However, when milk leakage was added to the model, the significance of cabergoline was reduced. We interpreted this to show that milk leakage is an intervening variable between treatment with cabergoline and lower risk of new IMI. The antibiotic treatment significantly decreased the odds of new IMI compared with both cabergoline and placebo. However, because several countries are currently disallowing the preventive use of antibiotics at dry-off in noninfected quarters, the dry-off facilitator cabergoline may therefore be of particular value to reduce the risk of new IMI across the dry period.

Dopaminergic and Antidopaminergic Effects on Heart Rate in Healthy Horses When Challenged With Brief 2-minute Exercise Bouts

Bromocriptine is a dopamine receptor agonist known to cause hypotension and bradycardia in several species. Five experiments were conducted to compare possible perturbations on heart rate (HR) in horses after a brief (2 minutes) exercise bout when exposed to either short-term or long-term treatment with bromocriptine, cabergoline, or pergolide (all commonly used dopaminergic agonists in horses) or sulpiride, a dopaminergic antagonist. For all experiments, prolactin was measured as an indicator of drug efficacy. Experiments 1 and 4 were conducted as a replicated Latin square, whereas experiments 2, 3, and 5 were double split plot designs. Experiment 1 tested changes in HR, adrenocorticotropin (ACTH), and growth hormone (GH) concentrations when geldings were pretreated with 50 mg of bromocriptine 12 hours before exercise. Bromocriptine pretreatment reduced (P < .05) the exercise-induced rise in HR and the ACTH and GH responses (P < .05). Experiment 2 assessed the daily responses of HR to exercise after intramuscular administration of 5 mg of cabergoline in vegetable oil, which diminished the rise in HR because of exercise for the first 2 days of the 7-day experiment. In experiment 3, daily feeding of 2g of pergolide top dressed over sweet feed had no effect on HR in response to exercise. Similar results were seen in experiments 4 and 5, when horses were intravenously administered .01 mg/kg BW sulpiride in saline or intramuscularly administered 1g of sulpiride dissolved in vegetable oil. Taken together, bromocriptine and cabergoline, but not pergolide or sulpiride, dampened the cardiac sympathetic response to exercise, thus, lowering the HR.

Inhibiting prolactin by cabergoline accelerates mammary gland remodeling during the early dry period in dairy cows

The inhibition of prolactin release using cabergoline, a dopamine agonist, is an effective strategy to accelerate the changes in mammary secretion composition after drying-off. The objective of this study was to determine how cabergoline may affect mammary tissue remodeling during early involution. Holstein dairy cows were treated with either a single i.m. administration of 5.6 mg of cabergoline (Velactis, Ceva Santé Animale, Libourne, France, n = 7) or placebo (n = 7) at the time of drying-off. Mammary biopsy samples were collected 1 wk before drying-off (d -6), after 30 h of milk accumulation (d 1), and again 8 d following drying-off (d 8) to determine changes in gene expression, lactoferrin content, and cell turnover. Blood and mammary secretion samples were collected at d -6 and again at d 1, 2, 3, 4, 8, and 14 following the abrupt cessation of lactation to evaluate indicators of blood-milk barrier integrity and other markers of mammary tissue remodeling. Cabergoline induced less SLC2A1, BAX, CAPN2, and IGFBP5 mRNA expression. In contrast, cabergoline did not modify changes in cell proliferation and apoptosis. Following the cessation of lactation, changes in mammary secretion composition (Na+ and K+) and blood lactose concentrations were indicative of a loss in the blood-milk barrier function in both treatment groups. Cabergoline treatment affected only Na+ and K+ concentrations at d 1, suggesting a moderate increase in tight junction permeability. The increase in the activity of MMP9 and in mammary epithelial cell concentration in mammary secretions was greater in cabergoline-treated cows than in control cows, suggesting more mammary tissue remodeling. The increase in lactoferrin immunostaining in the mammary tissue occurred earlier for cabergoline-treated cows than for control cows, and was essentially localized in the stroma. Changes in some key markers of mammary involution suggest that cabergoline accelerates mammary gland remodeling. Thus, a single injection of cabergoline after the last milking would facilitate drying-off by enhancing mammary gland involution.

Effect of a single injection of cabergoline at dry off on udder characteristics in high-yielding dairy cows

In recent years, relationships between high milk yield at dry off, higher prevalence for new intramammary infections, and stress were evaluated. Considering increasing milk yield, dry off methods need to be refined to ensure udder health and animal welfare, especially in high-yielding dairy cows. The present work evaluated the effect of a single cabergoline injection (Velactis, Ceva Santé Animale, Libourne, France) at dry off on udder pressure, milk leakage, and signs of udder pain after dry off. A total of 234 high-yielding (≥16 kg of milk/d) dairy cows was enrolled 7 d before and followed up until 14 d after dry off. Cows were dried off without preparation (i.e., no feed change or intermittent milking before dry off) and treated with a single i.m. injection of 5.6 mg of cabergoline (n = 115) or placebo (n = 119) after last milking. Udder characteristics were measured 4 d before (i.e., before and after milking) and 1, 2, 3, 7, 10, and 14 d after dry off. Udder pressure was evaluated utilizing a hand-held dynamometer. Milk leakage and signs of udder pain were noted as binary variables. Whereas udder pressure baseline values after last milking did not differ between treatment groups (0.541 ± 0.15 kg), cabergoline significantly reduced udder pressure in primiparous but not in multiparous cows after dry off. Differences between cabergoline- and placebo-treated primiparous cows could be evaluated until 3 d after dry off. The first day after dry off, udder pressure in placebo- and cabergoline-treated cows increased by 115% and 42.3%, respectively. Whereas pressure values in placebo cows were highest on the first day after dry off (1.16 ± 0.61 kg) and slowly decreased afterward, udder pressure in cows treated with cabergoline had a slower increase and peak only 2 d after dry off (0.94 ± 0.44 kg). Furthermore, cabergoline caused a reduction of milk leakage, a known factor for new intramammary infections. Only 11.3% of cows treated with cabergoline showed milk leakage compared with 21.0% placebo-treated cows. Additionally, cows with placebo treatment were 2.8 times as likely to show signs of udder pain compared with cows treated with cabergoline. An effect of cabergoline on udder pressure, milk leakage, and udder pain was limited to the first week after dry off. Our data provide evidence that a single injection of cabergoline reduces risk factors for udder health and animal welfare problems around dry off in high-yielding dairy cows with more than 16 kg of milk/d. Further research is warranted, however, to investigate if cabergoline at dry off can also be used to reduce new intramammary infection rates and improve animal welfare after dry off.

Cabergoline inhibits prolactin secretion and accelerates involution in dairy cows after dry-off

Dairy cattle require a dry period between successive lactations to ensure optimal milk production. Because prolactin (PRL) is necessary for the initiation and maintenance of milk production, strategies that can inhibit PRL secretion might hasten the involution process. The objective of this study was to determine the effect of the PRL release inhibitor cabergoline on markers of mammary gland involution during the early dry period. To assess the effect of cabergoline treatment on mammary gland involution, 14 Holstein dairy cows in late lactation were treated with either a single i.m. administration of 5.6mg of cabergoline (Velactis, Ceva Santé Animale, Libourne, France, n=7) or placebo (n=7) at the time of dry-off. Blood samples and mammary secretion samples were collected 6d before dry-off and again 1, 2, 3, 4, 8, and 14d following the abrupt cessation of lactation. Blood samples were used to determine plasma PRL concentrations. Mammary secretion samples were used to determine somatic cell count, milk fat, lactose, true protein content, and concentrations of α-lactalbumin, lactoferrin, and citrate. Following the cessation of lactation, changes in mammary secretion composition indicated diminished milk synthesis, including reduced concentrations of α-lactalbumin, citrate, and lactose. In contrast, milk somatic cell count, percent total protein, percent fat content, and lactoferrin concentrations significantly increased as involution progressed. Cabergoline treatment decreased the plasma PRL concentrations during the first week of dry-off, compared with the control treatment. No significant differences in citrate, α-lactalbumin, or protein content were observed between treatment groups. The most dramatic changes in secretion composition as a consequence of cabergoline treatment occurred during the first week of the dry period, when lactose concentrations and the citrate:lactoferrin molar ratio were lower and lactoferrin concentrations higher than in the control cows. Cabergoline treatment also tended to increase fat content and somatic cell count more rapidly following dry-off compared with the control group. These changes in mammary secretion composition following the abrupt cessation of lactation indicate that cabergoline treatment facilitated dry-off and effectively accelerated mammary gland involution.

Cabergoline for preventing ovarian hyperstimulation syndrome in women at risk undergoing in vitro fertilization/intracytoplasmic sperm injection treatment cycles: A randomized controlled study.

Background:Ovarian hyperstimulation syndrome (OHSS) is the most serious and potentially life-threatening iatrogenic complication associated with ovarian stimulation during assisted reproductive technology protocols. The aim of this study was to evaluate the role of dopamine agonist as a preventive strategy of OHSS in women at high risk in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment cycles.Methods:Seventy women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included. The study group received 0.5 mg of cabergoline for 8 days from the day of human chorionic gonadotropin administration in comparison to those who undergo no treatment for the prevention of OHSS. The reduction of the incidence of OHSS was the primary outcome.Results:The actual incidence of OHSS was 8.33% in the cabergoline group and 20.58% in the control group. Thus, the incidence of OHSS was significantly reduced, by almost 60%, in the cabergoline group in comparison with the control group (relative ratios: 0.4, 95% confidence interval: 0.18–0.79).Conclusion:Prophylactic treatment with the dopamine agonist, cabergoline, reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment. However, the effects of cabergoline on important outcomes, namely, live birth, miscarriage, and congenital abnormalities are still uncertain.

Short communication: The effects of cabergoline administration at dry-off of lactating cows on udder engorgement, milk leakages, and lying behavior

Cabergoline is an ergot derivative with high affinity for the D2 dopamine receptors whose dopaminergic effects cause inhibition of prolactin (PRL) secretion; thus, it could be considered a molecule that acts as a potential dry-off facilitator. One hundred ninety-nine Holstein cows (102 primiparous; 97 multiparous) producing ≥18kg/d at dry-off were split in 2 treatments to evaluate the effects of diminishing PRL secretion at dry-off (between 70 and 50 d from the expecting calving date) on udder engorgement, milk leakage, and cow well-being after dry-off. Treatments consisted of a single i.m. injection of 5mL of a solution containing 5.6mg of cabergoline (CAB; Velactis, Ceva Santé Animal, Libourne, France) or 5mL of saline solution as a placebo (CTRL). Each animal was evaluated for presence or absence of milk leakages during the 4 d following dry-off and udder engorgement was determined using a digital algometer. Lying behavior was recorded during 10 d after dry-off. Twenty-five cows from each treatment were randomly chosen and blood sampled at 3 and 15 d after dry-off, and again at 5 and 3 d before the expected calving date to determine serum PRL concentrations. Cows on CAB had lower serum PRL concentrations than cows on CTRL at 3 and 15 d after dry-off. Average udder engorgement was lower for cows on CAB than for cows on CTRL following dry-off, and it decreased as days after dry-off increased. The overall incidence of milk leakage in cows on CAB (3.1±0.88%) was 73.5% of that obtained in cows on CTRL (11.7±1.64%); cows on CAB had 0.2 lower odds of incurring milk leakage than cows on CTRL. The day following dry-off, CAB cows lied about 1.5h/d more than cows on CTRL. We conclude that i.m. administration of 5.6mg of cabergoline at dry-off effectively reduces PRL secretion, udder engorgement, and milk leakages, and improves lying time the day following dry-off.

Menopause and prolactin secreting tumours

ABSTRACT Introduction Prolactinomas without galactorhhea may be considered menopause or not diagnosed. This is a cases series. Case1. 76-year female with menopause at age of 52 was discovered at 66 yrs with high prolactin and a pituitary micro-nodule. Bromocriptin was continued for 6 years then switched to cabergoline with constant imagery. The patient did not display at all galactorrhea. Osteoporosis was diagnosed at age of 66 with previous 2 fragility fractures. Case2. 45-year female is known with secondary amenorrhea (without galactorrhea) for the last 7 years being considered menopause. She experienced headaches thus a MRI was performed and found a pituitary tumour of 1.5cm. Low FSH with increased prolactin was revealed. Cabergoline was started. Within 2 months the menses resumed and headache mildly improved. After 3 months prolactin normalised under weekly 2 mg of cabergoline. Periodical prolactin control is necessary as well as a pituitary scan at 6 months. Case3. 39-year female had a 3 yrs history of secondary amenorrhea. A prolactin of 117ng/mL and a microprolactinoma of 0.77cm were found. Cabergoline was started and progressively increased up to 1.5mg per week. The prolactin quickly normalised up to 8ng/mL within 4 months. She was followed for 2 years and the imagery found a tumour reduction to 0.44cm. Conclusion Prolactinomas associate a great variety of clinical presentations. They interfere with menopause by mimicking it in cases without galactorrhea. Also a newly diagnosed prolactinoma during menopause needs long term therapy and followed-up for especially for bone safety.

Long-term Treatment of Insulin-insensitive Mares with Cabergoline: Effects on Prolactin and Melanocyte Stimulating Hormone Responses to Sulpiride and on Indices of Insulin Sensitivity

The main experiment assessed whether the inhibitory effects of the dopamine agonist, cabergoline, on prolactin and α-melanocyte stimulating hormone (MSH) concentrations would persist throughout a longer-term administration (65 days). The possible effect of cabergoline on insulin sensitivity was also studied. Ten mares known to be insulin insensitive were allotted to two groups (treated vs. control). An insulin challenge, a glucose tolerance test, and a sulpiride challenge were administered before treatment. On day 0, treated mares (n = 5) received an injection of 5 mg cabergoline in slow-release vehicle; control mares (n = 5) received an equivalent vehicle injection. Injections were repeated every 10 days for a total of seven injections. Sulpiride challenges were done 1 day before each cabergoline treatment to assess possible refractoriness to the treatment. Behavior and hair coat density were also monitored. Plasma prolactin was suppressed (P < .01) to undetectable levels in mares receiving cabergoline; control mares had robust prolactin responses to each sulpiride injection. There was no indication of refractoriness to cabergoline over time. Plasma MSH concentrations after sulpiride were also suppressed (P < .05) by cabergoline. After treatment, neither the glucose response to insulin nor the insulin response to glucose differed (P > .1) between groups. No behavioral changes were noted because of treatment. Weight of hair samples indicated that cabergoline perturbed (P < .05) winter coat growth. It is concluded that 5 mg of cabergoline in slow-release vehicle administered every 10 days is an effective way of delivering dopaminergic activity to mares that results in no noticeable detrimental effects and no refractoriness to the drug.

Index of Suspicion

* ALT: : alanine aminotransferase AST: : aspartate aminotransferase BUN: : blood urea nitrogen CBC: : complete blood count CNS: : central nervous system CSF: : cerebrospinal fluid CT: : computed tomography ECG: : electrocardiography ED: : emergency department EEG: : electroencephalography ESR: : erythrocyte sedimentation rate GI: : gastrointestinal GU: : genitourinary Hct: : hematocrit Hgb: : hemoglobin MRI: : magnetic resonance imaging WBC: : white blood cell An 11-year-old boy presents to the emergency department with a 1-week history of frequent episodes of nonbloody, nonbilious emesis associated with diarrhea and abdominal cramping. He has urgency and fecal incontinence. He has been afebrile and denies any rashes, joint pain, sick contacts, headaches, or other symptoms. On further questioning, his mother reveals that he has had 2 similar episodes of abdominal distension and diarrhea during the past 6 to 7 years. Between these episodes, she states that he normally has nonbloody, hard stools accompanied by straining and chronic abdominal pain and pain with defecation. When asked specifically, his mother does not remember when he passed his first stool after he was born. On physical examination, his temperature is 37.6°C, pulse is 100 beats per minute, respiratory rate is 16 breaths per minute, blood pressure is 113/62 mm Hg, oxygen saturation is 100% on room air, height is 63 inches (95%), and weight is 36.7 kg (25%). He has abdominal distention and diffuse abdominal tenderness with voluntary guarding. There is palpable stool in the left quadrant. There is no perianal erythema or skin tag, and rectal examination reveals a low anal tone. A CT scan of the abdomen (Figure 1) reveals a markedly distended rectosigmoid colon with circumferential, confluent, and contiguous mural thickening. Basic metabolic profile, CBC, and urinalysis results are unremarkable, but the C-reactive protein level is elevated at 131 mg/L (1248 nmol/L). Because of the concern for enterocolitis, he is empirically given broad-spectrum intravenous antibiotics and transferred to a children’s hospital for further evaluation. Figure 1. A CT scan of the abdomen shows a markedly distended rectosigmoid colon with circumferential mural thickening. A 4-year-old boy presents for evaluation of intermittent fevers of 4 weeks’ duration after 2 separate antibiotic courses prescribed for acute otitis media. He has experienced clear rhinorrhea and …

Inhibitory Effects of Pergolide and Cabergoline Formulations on Daily Plasma Prolactin Concentrations in Geldings and on the Daily Prolactin Responses to a Small Dose of Sulpiride in Mares

Two experiments were conducted to assess the efficacy and duration of action of two dopaminergic compounds, pergolide and cabergoline, on daily prolactin secretion in geldings and on prolactin responses to a small dose of sulpiride over 10 days. In the first experiment, oral administration of 2 mg of pergolide was compared to a single injection of 2 mg of pergolide in a slow-release vehicle and a single injection of 5 mg of cabergoline in slow-release vehicle. Controls received vehicle only. All drug treatments reduced (P < .05) prolactin concentrations relative to that in controls but differed substantially in duration of action (oral pergolide approximately 6 hours or less, injected pergolide 6 to 24 hours, and injected cabergoline at least 6 days). In the second experiment, repeated small doses of sulpiride (2 μg/kg of body weight intravenously) were used to stimulate prolactin release in mares, and the ability of seven daily injections of pergolide (2 mg each) and a single injection of cabergoline (5 mg) in slow-release vehicle to suppress this release were compared. Control mares receiving vehicle injections had robust prolactin responses to the sulpiride injections on all days of injection (days 1, 0, 1, 2, 3, 4, 6, 8, and 10 relative to treatment). Prolactin responses were muted (P < .05) by pergolide and cabergoline treatments on the first day of injection (day 0, 30 min after treatment) and were basically absent on days 1 to 8. The single injection of cabergoline continued to be suppressive through day 10, whereas mares previously treated with pergolide (through day 6) had begun to recover a prolactin response by day 10. We conclude that either daily 2-mg pergolide injections in slow-release vehicle or a single injection of 5 mg of cabergoline in slow-release vehicle is an effective way to apply dopaminergic activity to horses for approximately 7 to 10 days and may have application in the treatment of pituitary pars intermedia dysfunction in affected horses.

Can dopamine agonist at a low dose reduce ovarian hyperstimulation syndrome in women at risk undergoing ICSI treatment cycles? A randomized controlled study.

Dopamine agonists were proposed as a preventive strategy for severe ovarian. The aim of this randomized controlled study is to evaluate the role of dopamine agonist at lower doses (0.25mg) as a preventive strategy of severe hyperstimulation syndrome (OHSS) in women at high risk in IVF/ICSI treatment cycles. Two hundred women at risk to develop OHSS undergoing IVF/ICSI treatment cycle were included; the study group received 0.25mg of cabergoline for 8 days from the day of HCG administration versus no treatment for the prevention of OHSS. Reduction of the incidence OHSS was the primary outcome. The overall incidence of OHSS was significantly reduced, almost 50%, in cabergoline group in comparison with control group (RR: 0.5, 95% CI: 0.29-0.83), with absolute risk reduction following cabergoline administration 11% (ARR: 0.11, 95% CI: 1.09-20.91). The corresponding number needed to treat (NNT) was 9. Prophylactic treatment with the dopamine agonist, cabergoline, at lower doses (0.25mg) reduces the incidence of OHSS in women at high risk undergoing IVF/ICSI treatment.

The effects of cabergoline on ovarian hyperstimulation syndrome (OHSS) and pregnancy outcomes on in vitro fertilization (IVF) patients

ObjectiveTo compare the outcomes between patients who used cabergoline and those who did not to prevent ovarian OHSS while undergoing IVF.DesignRetrospective analysis.Materials and MethodsBetween 2008 and 2011, 120 patients at risk for OHSS received 0.5 mg of cabergoline daily starting on the day of HCG administration and 211 patients did not receive any treatment to prevent OHSS. Inclusion criteria included a maximum estradiol level greater than 3500. IVF stimulation regimens included long GnRH agonist and antagonist protocols with combined human menopausal gonadotropins (hMG) and recombinant follicle stimulating hormone (rFSH) protocols. Oocytes were fertilized and embryos were transferred or frozen as determined by their risk for OHSS. Moderate and severe OHSS were defined by Rizk's criteria.Statistical analysis was performing using the t-test for age, estradiol level, and oocytes retrieved. A chi square test was used for hospital admissions, rate of OHSS, and pregnancy rate.ResultsTable 1Comparison of patients recieving cabergoline (cabergoline) and patients who did not recieve treatment for prevention of OHSS (control).CabergolineControlP valueAge34.6 ± 4.733.5 ± 4.80.074MAXIMUM ESTRADIOL4780.4 ± 1114.84592.1 ± 998.40.067ESTRADIOL ON DAY OF HCG4003.9 ± 994.63714.2 ± 995.00.002*OOCYTES RETRIEVED16.3 ± 6.815.3 ± 6.50.228HOSPITALIZATION (%)1.74.60.167MODERATE OHSS (%)1.75.50.091SEVERE OHSS (%)0.00.90.294TOTAL OHSS (%)1.76.50.050*PREGNANCY (%)49.649.80.973* statistically significant Open table in a new tab ConclusionCabergoline administration did not affect the rate of hospital admissions or severe OHSS, however, did significantly reduce the total number of OHSS cases. In addition, using cabergoline did not affect overall clinical pregnancy rate. The overall incidence of OHSS is very low and despite the large numbers of treated subjects, a larger study may be necessary to generate sufficient power to accurately assess efficacy. ObjectiveTo compare the outcomes between patients who used cabergoline and those who did not to prevent ovarian OHSS while undergoing IVF. To compare the outcomes between patients who used cabergoline and those who did not to prevent ovarian OHSS while undergoing IVF. DesignRetrospective analysis. Retrospective analysis. Materials and MethodsBetween 2008 and 2011, 120 patients at risk for OHSS received 0.5 mg of cabergoline daily starting on the day of HCG administration and 211 patients did not receive any treatment to prevent OHSS. Inclusion criteria included a maximum estradiol level greater than 3500. IVF stimulation regimens included long GnRH agonist and antagonist protocols with combined human menopausal gonadotropins (hMG) and recombinant follicle stimulating hormone (rFSH) protocols. Oocytes were fertilized and embryos were transferred or frozen as determined by their risk for OHSS. Moderate and severe OHSS were defined by Rizk's criteria.Statistical analysis was performing using the t-test for age, estradiol level, and oocytes retrieved. A chi square test was used for hospital admissions, rate of OHSS, and pregnancy rate. Between 2008 and 2011, 120 patients at risk for OHSS received 0.5 mg of cabergoline daily starting on the day of HCG administration and 211 patients did not receive any treatment to prevent OHSS. Inclusion criteria included a maximum estradiol level greater than 3500. IVF stimulation regimens included long GnRH agonist and antagonist protocols with combined human menopausal gonadotropins (hMG) and recombinant follicle stimulating hormone (rFSH) protocols. Oocytes were fertilized and embryos were transferred or frozen as determined by their risk for OHSS. Moderate and severe OHSS were defined by Rizk's criteria. Statistical analysis was performing using the t-test for age, estradiol level, and oocytes retrieved. A chi square test was used for hospital admissions, rate of OHSS, and pregnancy rate. ResultsTable 1Comparison of patients recieving cabergoline (cabergoline) and patients who did not recieve treatment for prevention of OHSS (control).CabergolineControlP valueAge34.6 ± 4.733.5 ± 4.80.074MAXIMUM ESTRADIOL4780.4 ± 1114.84592.1 ± 998.40.067ESTRADIOL ON DAY OF HCG4003.9 ± 994.63714.2 ± 995.00.002*OOCYTES RETRIEVED16.3 ± 6.815.3 ± 6.50.228HOSPITALIZATION (%)1.74.60.167MODERATE OHSS (%)1.75.50.091SEVERE OHSS (%)0.00.90.294TOTAL OHSS (%)1.76.50.050*PREGNANCY (%)49.649.80.973* statistically significant Open table in a new tab * statistically significant ConclusionCabergoline administration did not affect the rate of hospital admissions or severe OHSS, however, did significantly reduce the total number of OHSS cases. In addition, using cabergoline did not affect overall clinical pregnancy rate. The overall incidence of OHSS is very low and despite the large numbers of treated subjects, a larger study may be necessary to generate sufficient power to accurately assess efficacy. Cabergoline administration did not affect the rate of hospital admissions or severe OHSS, however, did significantly reduce the total number of OHSS cases. In addition, using cabergoline did not affect overall clinical pregnancy rate. The overall incidence of OHSS is very low and despite the large numbers of treated subjects, a larger study may be necessary to generate sufficient power to accurately assess efficacy.