NHSL Medicines Guidance
Specialist initiation (S1)
- Pre-pregnancy or quinagolide intolerant.
- Quinagolide intolerant.
Prescribing Notes:
- QUINAGOLIDE is the treatment of choice as it is a non-ergot agent and does not cause fibrosis or valvular heart disease.
- CABERGOLINE may be better tolerated than BROMOCRIPTINE. However, there is little information on its use in pregnancy. BROMOCRIPTINE is the drug of choice for hyperprolactinaemia if pregnancy is sought.
- For suppression of lactation, see Chapter 7 – Drugs used in Obstetrics.
- The CSM has advised that CABERGOLINE and BROMOCRIPTINE have been associated with pulmonary, retroperitoneal and pericardial fibrotic reactions. Before starting treatment with these drugs it may be appropriate to measure the ESR, 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.
- Excessive daytime sleepiness and sudden onset of sleep can occur and patients should be warned of these possible effects and exercise caution when driving, operating machinery or working at heights.