Dopamine receptor agonists

• Parkinson's disease
• prolactinoma/galactorrhoea
• cyclical breast disease
• acromegaly

Currently accepted practice in the management of patients with Parkinson's disease is to delay treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist. If the patient is elderly, L-dopa is sometimes used as an initial treatment

• e.g. bromocriptine, ropinirole, cabergoline, apomorphine
• ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide*) have been associated with pulmonary, retroperitoneal and cardiac fibrosis. The Committee on Safety of Medicines advice that an ESR, creatinine and chest x-ray should be obtained prior to treatment and patients should be closely monitored

• nausea/vomiting
• postural hypotension
• hallucinations
• daytime somnolence

*pergolide was withdrawn from the US market in March 2007 due to concern regarding increased incidence of valvular dysfunction