Makindo Medical Notes

Related Subjects: |Male Infertility |Prolactin |Prolactinoma |Sheehan's syndrome |Dopamine agonists

⚠️ 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.