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  1. Niamh M Martin, clinical senior lecturer and honorary consultant endocrinologist,
  2. Tricia Tan, consultant physician in metabolic medicine,
  3. Karim Meeran, professor of endocrinology
  1. 1Endocrine Unit, Department of Investigative Medicine, Imperial College Healthcare NHS Trust and Imperial College, London W12 0NN
  1. n.martin{at}imperial.ac.uk

    Safety concerns must be supported by evidence before practice is changed

    Cabergoline and bromocriptine are both ergot based dopamine receptor agonists. Cabergoline has been used for the past 15 years to treat hyperprolactinaemia and is the first line treatment for prolactinomas. Despite its higher cost, cabergoline has largely superseded bromocriptine because of its greater efficacy in suppressing prolactin secretion, better tolerability, and more convenient dosing regimen. Recently, the Medicines and Healthcare Products Regulatory Agency (MHRA) issued a warning about the safety of these agents for treating hyperprolactinaemia amid concerns of an association with chronic pleuropulmonary, pericardial, and retroperitoneal fibrosis, and particularly fibrotic valvular heart disease.1

    Cabergoline and bromocriptine—in common with other ergot based drugs such as ergotamine, methysergide, and the weight loss drugs fenfluramine and dexfenfluramine—bind to the serotonin receptor subtype 2B (5-HT2B) located on heart valves. It has …

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