Dopamine Receptor Agonists

Key points

• Indications: acromegaly · Parkinson's disease · prolactinoma/galactorrhoea · cyclical breast disease.
• Examples: bromocriptine, cabergoline, ropinirole, apomorphine.
• Ergot-derived agents (bromocriptine, cabergoline, pergolide): pulmonary/retroperitoneal/cardiac fibrosis risk — CSM advised ESR, creatinine, CXR before treatment; pergolide withdrawn in the US (2007, valvular dysfunction).
• Adverse effects: nausea/vomiting, postural hypotension, hallucinations, daytime somnolence.
• Parkinson's: delay treatment until disabling symptoms, then dopamine agonist (elderly may start L-dopa).

Decision points in this pathway

• Ergot-derived agent?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.