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Patients and their carers should be informed about the risk of impulse control disorders (including pathological gambling, binge eating, and hypersexuality) associated with dopamine-receptor agonists. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended.
If the patient develops an impulse control disorder, the dopamine-receptor agonist should be withdrawn or the dose reduced until the symptoms resolve.
Ergot-derived dopamine-receptor agonists, bromocriptine, cabergoline, and pergolide, have been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions.
Exclude cardiac valvulopathy with echocardiography before starting treatment with these ergot derivatives for Parkinson's disease or chronic endocrine disorders (excludes suppression of lactation); it may also be appropriate to measure the erythrocyte sedimentation rate and serum creatinine and to obtain a chest X-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness. If long-term treatment is expected, then lung-function tests may also be helpful.
Patients taking cabergoline should be regularly monitored for cardiac fibrosis by echocardiography (within 3–6 months of initiating treatment and subsequently at 6–12 month intervals).
Refer to MHRA Drug Safety Update (October 2008), and individual summary of product characteristics for further details regarding fibrotic reactions.
Indications and dose
Notes
Indications and dose
Notes