AACE/ACE Disease State Clinical Review: Dopamine Agonists for Hyperprolactinemia and the Risk of Cardiac Valve Disease

Endocr Pract. 2014 Jun;20(6):608-16. doi: 10.4158/EP14148.RA.

Abstract

Objective: To review the current literature regarding dopamine agonists (DAs) and the risk of the development of cardiac valve disease.

Methods: PubMed searches were performed to identify all of the available published data on DAs and valve disease in patients with hyperprolactinemia.

Results: Most of the available echocardiographic data from patients treated for hyperprolactinemia are from case-control studies, and prospective data are limited. The majority of the studies do not support an increased risk of clinically significant valve disease in hyperprolactinemic patients treated with cabergoline. Evidence for the use of echocardiography is needed to limit unnecessary procedures and healthcare costs. Based on the published literature describing Parkinson's disease (PD) patients, the daily and cumulative doses of cabergoline are important factors. Considerations to minimize exposure to cabergoline, such as surgical resection of adenomas or medication withdrawal in responders, may be appropriate depending on the clinical setting.

Conclusion: There is no conclusive evidence that cabergoline causes clinically significant cardiac valve disease at the usual doses for the treatment of hyperprolactinemia. Although current recommendations from regulatory agencies advise routine echocardiography for patients receiving cabergoline, evidence-based criteria would be useful both to identify patients at risk and generate appropriate screening protocols.

MeSH terms

  • Cabergoline
  • Dopamine Agonists / adverse effects*
  • Ergolines / adverse effects*
  • Heart Valve Diseases / chemically induced*
  • Humans
  • Hyperprolactinemia / drug therapy*
  • Risk

Substances

  • Dopamine Agonists
  • Ergolines
  • Cabergoline