⚠️ Some ergot-derived dopamine agonists (e.g. cabergoline, pergolide, bromocriptine) have been associated with fibrotic reactions such as retroperitoneal fibrosis and valvular heart disease (↑ mitral, aortic, and tricuspid regurgitation). 💡 Non-ergot agonists are now preferred due to better safety profiles. Always check the BNF or local guidance for up-to-date prescribing advice.

💊 About

Dopamine agonists can be used as initial therapy in idiopathic Parkinson’s disease, or as adjuncts to levodopa in later stages.
They act directly on D1–D4 dopamine receptors.
Non-ergot agents (ropinirole, pramipexole) are preferred in current practice.

📌 Types

Ergot-derived: Bromocriptine, Cabergoline, Pergolide, Lisuride
Non-ergot-derived: Ropinirole, Pramipexole
Other: Apomorphine (used in advanced PD via syringe driver)

🎯 Indications

Parkinson’s disease: monotherapy in early disease, or in combination with levodopa later.
Prolactinoma: low-dose cabergoline or bromocriptine to reduce prolactin levels.
Lactation suppression: occasionally used to prevent unwanted lactation (rarely now).

🚫 Contraindications

Valvular heart disease (ergot derivatives).
History of pulmonary, retroperitoneal, or pericardial fibrosis.
Severe psychiatric illness (hallucinations, confusion can worsen).

💊 Examples of Dosing (BNF check required)

Bromocriptine: Dopamine D2 agonist; start low and titrate slowly.
Cabergoline / Pergolide / Lisuride: now rarely used due to fibrosis risk.
Ropinirole / Pramipexole: common first-line non-ergot dopamine agonists.
Apomorphine: rescue therapy in advanced disease (syringe driver or intermittent injection).

⚠️ Side Effects

GI: nausea, anorexia (may be reduced with domperidone, a peripheral dopamine blocker).
Neuropsychiatric: confusion, delirium, hallucinations, somnolence.
Impulse control disorders: online gambling, hypersexuality, compulsive shopping/eating.
Motor: dyskinesias, orthostatic hypotension.
Fibrosis (ergot derivatives): valvular, retroperitoneal, pulmonary fibrosis.

💡 Pearls: - Always baseline and periodic echo if using ergot-derived agents. - Screen patients for history of psychiatric illness before starting. - Consider dopamine agonists in younger patients with Parkinson’s to delay levodopa-induced motor complications. - Monitor closely for impulse control disorders and counsel patients + families.

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Dopamine agonists 💊