Q: Can Cabergoline raise the ferritin level? I have hereditary haemochromatosis and had a ferritin level of 1000. After 23 weekly phlebotomies my level dropped to 214. The endocrinologist put me on Cabergoline, as my prolactin level was 91 after I had been taking Bromocriptine 2.5 and had too many side effects. I went back to my haematologist and after a month of no phlebotomies, my ferritin level was up to 1413 although the prolactin level is down to 19.1. The haematologist doesn't know the reason behind the increase in ferritin level in one month. He suggested stopping Cabergoline. I will be starting the weekly phlebotomies again this week. Please advise.

A:The effect of cabergolin on iron metabolism has not been specifically studied. However no reports of its effect on ferritin level have been received. In symptomatic hereditary haemochromatosis, the usual ferritin level can fluctuate between 900 to 6,000mcg/L. Hence your level of 1,413 is not exceptional. The only issue is whether rise of titre from 214 to 1,413 within a span of over a month is abnormal. Here the dietary intake of iron in food consumed may play a role as well as urinary excretion i.e. urinary iron in mg per 24 hours. One should also keep in mind that ferritin level from 1,000 to 214 fell after 23 weekly phlebotomies i.e. over 5 months period. Due to excessive iron absorption, the ferritin level can shoot up. However I am in agreement with your doctor that cabergoline should be discontinued for a while to see its impact. Discontinuation of cabergoline for a month or two will not produce any irreversible adverse effects.