Dopamine agonists and hyperprolactinaemia

doi:10.1136/bmj.b381

Published 3 March 2009, doi:10.1136/bmj.b381
Cite this as: BMJ 2009;338:b381

Editorials

Dopamine agonists and hyperprolactinaemia

Safety concerns must be supported by evidence before practiceis changed

The first 150 words of the full text of this article appear below.

Cabergoline and bromocriptine are both ergot based dopaminereceptor agonists. Cabergoline has been used for the past 15years to treat hyperprolactinaemia and is the first line treatmentfor prolactinomas. Despite its higher cost, cabergoline haslargely superseded bromocriptine because of its greater efficacyin suppressing prolactin secretion, better tolerability, andmore convenient dosing regimen. Recently, the Medicines andHealthcare Products Regulatory Agency (MHRA) issued a warningabout the safety of these agents for treating hyperprolactinaemiaamid concerns of an association with chronic pleuropulmonary,pericardial, and retroperitoneal fibrosis, and particularlyfibrotic valvular heart disease.¹

Cabergoline and bromocriptine—in common with other ergotbased drugs such as ergotamine, methysergide, and the weightloss drugs fenfluramine and dexfenfluramine—bind to theserotonin receptor subtype 2B (5-HT_2B) located on heart valves.It has been proposed that activation of this receptor by theseagents induces proliferation of valvular interstitial cells,leading to valvular heart disease. . . . [Full text of this article]

Niamh M Martin, clinical senior lecturer and honorary consultant endocrinologist, Tricia Tan, consultant physician in metabolic medicine, Karim Meeran, professor of endocrinology

¹ Endocrine Unit, Department of Investigative Medicine, Imperial College Healthcare NHS Trust and Imperial College, London W12 0NN

n.martin@imperial.ac.uk