ergoline and Lung-Diseases

Classic ergolines, such as bromocriptine, methysergide and ergotamine, can induce chronic pleuropneumonitis. We present the cases of eight patients who developed similar changes whilst on other ergolines. In this retrospective case study spanning 1985-1995, clinical data, radiological material, pulmonary function, bronchoalveolar lavage and histopathology were reviewed. Earlier literature on ergoline-induced pleuropulmonary changes was reviewed. Eight middle-aged to elderly individuals of both sexes developed pleuropulmonary changes during long-term therapy with regular dosages of nicergoline (n = 4), dihydroergocristine (n = 3), or dihydroergotamine (n = 1). Bibasilar pleural thickening with or without pleural effusion was present on chest radiographs and computed tomographic (CT) scans in six cases. Increased erythrocyte sedimentation rate was seen in most. Pure interstitial pneumonitis developed in two patients on dihydroergocristine and was reversible in each. Bronchoalveolar lavage was performed in four cases and was abnormal in all, but demonstrated no consistent pattern. Most patients exhibited lung restriction. The outcome was favourable showing slow improvement in all cases following discontinuation of the ergoline. Slight residual pleural thickening was seen in five out of the six cases with pleural involvement. Nicergoline and dihydroergotamine can induce a syndrome of chronic pleural thickening/effusion that slowly improves after drug withdrawal. Dihydroergocristine can induce reversible interstitial pneumonitis.

Topics: Aged; Aged, 80 and over; Biopsy, Needle; Bronchoalveolar Lavage; Ergolines; Female; Humans; Lung Diseases; Lung Diseases, Interstitial; Male; Middle Aged; Pleural Diseases; Prognosis; Respiratory Function Tests; Survival Rate; Tomography, X-Ray Computed

Cabergoline, a dopamine agonist used to treat hyperprolactinemia, is associated with an increased risk of fibrotic adverse reactions, e.g. cardiac valvular fibrosis, pleuropulmonary, and retroperitoneal fibrosis.. This study evaluated the prevalence and risk of fibrotic adverse reactions during cabergoline therapy in hyperprolactinemic and acromegalic patients.. A cross-sectional study was conducted in a University Hospital.. A total of 119 patients with hyperprolactinemia and acromegaly who were on cabergoline therapy participated in the study.. All patients were requested to undergo a cardiac assessment, pulmonary function test, chest X-ray, and blood tests as recommended by the European Medicine Agency. Matched controls were recruited to compare the prevalence of valvular regurgitation. Cardiac valvular fibrosis was evaluated by assessing valvular regurgitation and the mitral valve tenting area (MVTa). The risk of pleuropulmonary fibrosis was assessed by a pulmonary function test, a chest X-ray, and if indicated, by additional imaging studies.. The prevalence of clinically relevant valvular regurgitation was not significantly different between cases (11.3%) and controls (6.1%; P=0.16). The mean MVTa was 1.27+/-0.17 and 1.24+/-0.21 cm(2) respectively (P=0.54). Both valvular regurgitation and the MVTa were not related to the cumulative dose of cabergoline. A significantly decreased pulmonary function required additional imaging in seven patients. In one patient, possible early interstitial fibrotic changes were seen. Lung function impairment was not related to the cumulative cabergoline dose.. Cabergoline, typically dosed for the long-term treatment of hyperprolactinemia or acromegaly, appears not to be associated with an increased risk of fibrotic adverse events.

Topics: Acromegaly; Blood Sedimentation; C-Reactive Protein; Cabergoline; Creatinine; Cross-Sectional Studies; Dopamine Agonists; Echocardiography; Electrocardiography; Ergolines; Female; Fibrosis; Glomerular Filtration Rate; Heart Valve Diseases; Heart Valves; Humans; Hyperprolactinemia; Lung; Lung Diseases; Male; Middle Aged; Respiratory Function Tests; Retroperitoneal Fibrosis; Statistics, Nonparametric

Topics: Aged; Antiparkinson Agents; Cabergoline; Ergolines; Female; Humans; Lung Diseases

We report a case of pleural effusion, pericardial thickening, and pulmonary involvement in a patient with dry cough, dyspnea, edema, and changes in the skin of the lower limbs. Treatment with cabergoline (Sogilen) had been started 4 months earlier. Pleural effusion, pericardial thickening, and impaired pulmonary function (airflow obstruction, increased airway resistance, and reduced carbon monoxide diffusing capacity) were observed. The Naranjo scale pointed to a probable relationship between cabergoline and these adverse effects. We report on outcome after 2 months of follow-up, during which time there was a slow and incomplete improvement in respiratory function. This is the first case in our practice setting of early pleuropulmonary toxicity associated with cabergoline.

Topics: Aged; Antiparkinson Agents; Cabergoline; Ergolines; Humans; Lung Diseases; Male; Pleural Effusion; Time Factors

Cabergoline is one of several ergoline dopamine agonist medications used in the treatment of Parkinson's disease (PD). We diagnosed constrictive pericarditis (CP) in a patient with PD receiving cabergoline therapy (10 mg daily), who had symptoms and signs of congestive heart failure (CHF). In the absence of previous reported cases of this condition linked to ergoline drugs, cabergoline was not initially identified as the cause. Shortly thereafter, however, the patient developed of a severe pleuropulmonary inflammatory-fibrotic syndrome, a recognized complication of ergoline medications, thus suggesting a common pathogenesis due to cabergoline therapy. To our knowledge, this is the first case in the English literature, although we speculate that CP may be more common than reported among patients with PD who are treated with an ergoline drug (cabergoline, bromocriptine, pergolide, or lisuride). The diagnosis of CP is difficult and requires a high level of suspicion; symptoms may masquerade as CHF due to common mechanisms such as coronary artery disease. In patients with PD who are taking not only cabergoline but also one of the other ergoline drugs, CP should be suspected if symptoms of CHF develop.

Topics: Aged; Antiparkinson Agents; Cabergoline; Dopamine Agonists; Ergolines; Humans; Lung Diseases; Male; Parkinson Disease, Secondary; Pericarditis, Constrictive; Pleural Diseases; Tomography, X-Ray Computed

A patient with Parkinson's disease, initially treated with bromocriptine and subsequently with cabergoline, developed progressive pleuropulmonary abnormalities during the latter therapy. These lesions even worsened for some weeks after interruption of cabergoline, which may possibly be related to the prolonged action of this drug. Thus cabergoline may cause similar pleuropulmonary abnormalities to bromocriptine.

Topics: Bromocriptine; Cabergoline; Dopamine Agents; Ergolines; Humans; Lung Diseases; Male; Middle Aged; Parkinson Disease; Pleural Effusion

Artificial dopamine agonists are widely employed for the treatment of idiopathic parkinsonism. Pleuropulmonary disease has previously been reported to occur with the use of bromocriptine and mesulergine. We report similar adverse effects induced by the newer agonists lisuride and cabergoline. All these agents are tetracyclic ergot derivatives. This suggests a causal link between ergot-derived dopamine agonists and pleuropulmonary disease.

Topics: Aged; Cabergoline; Dopamine Agents; Ergolines; Female; Humans; Lisuride; Lung Diseases; Male; Middle Aged; Parkinson Disease; Pleural Diseases; Radiography

Pleuropulmonary disease has been observed in eight patients with Parkinson's disease treated with bromocriptine or its related compound, mesulergine. The pleuropulmonary changes included pleural effusions, pleural thickening, and parenchymal lung disease. The patients developed symptoms from nine months to four years after starting treatment with bromocriptine that varied in dosage from 22 to 50 mg daily, while the patient receiving mesulergine was taking 6 mg daily. No other cause was found for the pleuropulmonary changes. In six patients the medication was discontinued with subsequent clinical, physiologic, and radiologic improvement. In two patients bromocriptine treatment was continued for one to two years, and in one patient there was further physiologic and radiologic progression of the pleuropulmonary changes. These findings suggest a causal relationship between bromocriptine treatment and pleuropulmonary disease. We recommend a chest roentgenogram and pulmonary function evaluation prior to bromocriptine treatment with follow-up studies if the patient develops respiratory symptoms. Physicians prescribing bromocriptine should be aware of this side effect to ensure early recognition and prompt withdrawal of bromocriptine therapy.

Topics: Aged; Antiparkinson Agents; Bromocriptine; Ergolines; Humans; Lung Diseases; Male; Middle Aged; Parkinson Disease; Pleural Diseases; Radiography