New safety advice for dopamine agonists in the treatment of prolactinoma and acromegaly
October 20th, 2008
Endocrinologists have been issued new guidance on how to manage patients receiving ergot derived dopamine agonists, most commonly used to treat prolactinomas or who have excessively high prolactin, the hormone that leads to lactation or milk production from the breasts.
This class of drugs include bromocriptine, cabergoline, lisuride and pergolide. The European Medicines Agency updated their advice on the use of these drugs after patients who used them for a long time showed an increased risk of cardiac fibrosis –abnormal thickening of the heart valves. The presence of fibrosis may now be evident long before symptoms alert a physician to its presence. .
Patients should have an echocardiogram - a test that uses sound waves to create a moving picture of the heart – before they are given the drugs, particularly cabergoline and pergolide, to check for damage to the heart valves (cardiac valvulopathy), the guidelines say.
Once prescribed the drugs, patients should be monitored periodically for signs and symptoms of fibrosis in the lungs or heart and be vigilant for retroperitoneal fibrosis.
Dr Gerard Conway, consultant endocrinologist, comments “These drugs have been in common use for many years and although this risk is real, it is likely to be infrequent. All patients attending London Medical on long term treatment with dopamine agonist therapy should have a check echocardiogram and be reviewed at least annually by their endocrinologist”.
