ergoline and Retroperitoneal-Fibrosis

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

There is growing evidence that the ergot-derived dopamine agonists cabergoline and pergolide can cause fibrotic cardiac valvulopathy. Data on other fibrotic reactions and nonergot-derived dopamine agonists are sparse. Aim of this study was to investigate whether there are signals that dopamine agonists are related to cardiac and other fibrotic reactions. We identified all reports of fibrotic reactions at the heart, lung, and retroperitoneal space associated with dopamine agonists within the US Adverse Event Reporting System database. Disproportionality analyses were used to calculate adjusted reporting odds ratios (RORs). For ergot-derived dopamine agonists (bromocriptine, cabergoline, pergolide), the RORs of all reactions under study were increased, whereas no such increases were observed for nonergot-derived drugs (apomorphine, pramipexole, ropinirole, rotigotine). Fibrotic reactions due to ergot-derived dopamine agonists may not be limited to heart valves. For nonergot-derived dopamine agonists, no drug safety signals were evident.

Topics: Aged; Aged, 80 and over; Apomorphine; Benzothiazoles; Bromocriptine; Cabergoline; Databases, Factual; Dopamine Agonists; Endomyocardial Fibrosis; Ergolines; Female; Fibrosis; Heart Valve Diseases; Humans; Indoles; Male; Middle Aged; Pergolide; Pericarditis; Pleural Diseases; Pramipexole; Pulmonary Fibrosis; Retroperitoneal Fibrosis; Tetrahydronaphthalenes; Thiophenes; United States

Topics: Antipsychotic Agents; Cabergoline; Dopamine Agonists; Ergolines; Heart Valve Diseases; Humans; Methysergide; Pergolide; Receptor, Serotonin, 5-HT2B; Retroperitoneal Fibrosis; Serotonin 5-HT2 Receptor Agonists; Serotonin Antagonists

There are a large variety of dopamine agonists available. Especially de novo patients are treated with dopamine agonists to avoid dyskinesia. Dopamine agonists can be subdivided into ergoline and non-ergoline derivatives. This distinction raises the question whether there are differences in the effects to treat symptoms, not only in the side effects between the individual dopamine agonists but also between these two groups. Pergolide is now considered a second line drug because of its particularly high tendency towards valvular heart disease. Some authors claim that all ergoline-derivatives may cause this problem, while own results do not necessarily support this view. We recommend performing echocardiography on those patients being treated with an ergot-derivative. New data support the view that all dopaminergic drugs may cause somnolence and that there is no preference for non-ergots. It may be that the number of gamblers is slightly higher among patients treated with pramipexole than in others. Dopamine agonists with a high affinity to D3 receptors have a good anti-anhedonic potency. In cell culture all dopamine agonists studied so far show neuroprotective properties in cell culture. The introduction of a slow-release formulation for ropinirole and the rotigotine and lisuride patches have opened new ways of continuous dopamine receptor stimulation. Taken together, dopamine agonists show individual properties and there are differences between ergot and non-ergot derivatives.

Topics: Dopamine Agonists; Ergolines; Heart Valve Diseases; Humans; Parkinson Disease; Pulmonary Fibrosis; Retroperitoneal Fibrosis

Cardiac valvulopathy has been recently associated with the use of the ergot dopamine agonist (EDA) pergolide in Parkinson's disease (PD). Cabergoline a widely used, well-tolerated EDA which has also been recently implicated in relation to fibrotic side effects although the evidence base for this is not sound.. In PD patients on chronic cabergoline therapy, do symptoms suggestive of serosal/cardiac fibrosis imply underlying fibrotic lesions?. A retrospective data review of 234 PD cases from three UK centres, on chronic cabergoline monotherapy or adjunctive treatment to identify symptoms suggestive of pleuro-pulmonary, cardiac or retroperitoneal fibrosis. These causes were thereafter selectively examined by appropriate specialists with relevant investigations.. Out of 234 cases, 15 were identified with symptoms suggestive of respiratory, cardiac or abdominal systems involvement although subsequent investigations failed to reveal definite association with cabergoline except two cases with probable alveolitis and a possible association with cardiac murmur in one case. In spite of the deficiencies of a retrospective study, the results suggest a low risk of fibrotic side effects with cabergoline, particularly cardiac valvulopathy.

Topics: Adult; Aged; Aged, 80 and over; Antiparkinson Agents; Cabergoline; Ergolines; Female; Fibrosis; Heart Valve Diseases; Humans; Male; Middle Aged; Parkinson Disease; Pulmonary Fibrosis; Retroperitoneal Fibrosis; Retrospective Studies

Forty patients with hyperprolactinaemia were treated with metergoline (8 to 12 mg/day) for periods up to 5 years. Analysis of the results of clinical and biological tolerability showed that treatment was generally well tolerated and although 28 patients complained of drug-related side-effects of various kinds, principally nausea, these were usually mild, present at the beginning of treatment and disappeared spontaneously in spite of continued metergoline administration over a prolonged period. No patient stopped treatment because of side-effects. Laboratory parameters also stayed within normal levels and there was no evidence of any alterations in the ECG. It is concluded, therefore, that metergoline is a well-tolerated as well as an effective ergolinic compound for use in those patients in whom prolonged treatment with a prolactin-lowering drug is considered necessary.

Topics: Adenoma; Adult; Drug Tolerance; Ergolines; Female; Humans; Metergoline; Pituitary Neoplasms; Prolactin; Retroperitoneal Fibrosis; Time Factors

Topics: Adult; Ergolines; Female; Humans; Lysergic Acid Diethylamide; Male; Methysergide; Middle Aged; Retroperitoneal Fibrosis; Ureter; Ureteral Diseases; Urography

Topics: Ergolines; Humans; Male; Methysergide; Middle Aged; Migraine Disorders; Retroperitoneal Fibrosis; Urinary Tract Infections