A Comparison of the Efficacy and Safety of Pergolide and Bromocriptine in the Treatment of Hyperprolactinemia*

Lamberts, Steven W. J.; Quik, R. F. P.

doi:10.1210/jcem-72-3-635

Cited by 47 publications

(20 citation statements)

References 20 publications

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“…The overall PRL lowering effect of roxindol was comparable to that observed during previous bromocriptine therapy. Similar results have been obtained with ergot derivatives in several studies [9,12] as well as with another non-ergot drug, quinagolide (CV 205-502), in a double-blind trial [19].…”

Section: Discussionsupporting

confidence: 83%

“…The therapeutic efficiency is shared by other ergot derivatives with dopamine agonist activity such as lisuride [2], mesulergine [9], metergoline [6], pergolide [12], and terguride [7], as are the disadvantages. These include a high frequency of adverse reactions, sometimes even prohibiting effective treatment, and lack of response to therapy in a minority of patients.…”

mentioning

confidence: 99%

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Treatment of prolactinoma patients with the new non-ergot dopamine agonist roxindol: first results

Jaspers¹,

Benker²,

Reinwein³

1994

Clin Investig

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We studied the effects of the new non-ergot D2-dopamine agonist roxindol for the treatment of human prolactinomas. Roxindol is a non-ergot drug with additional 5-hydroxytryptamine type 1 A agonist and serotonin reuptake inhibitory activity. Ten patients with prolactin-secreting pituitary adenomas received roxindol three times daily at a dosage of 7.5-30 mg/day for at least 4 weeks according to a prospective protocol. All patients but one had received oral bromocriptine previously without normalization of prolactin levels. Serum prolactin profiles were analyzed once a week during the first month of therapy and at 4-week intervals thereafter. Mean baseline serum prolactin was suppressed from 23,000 +/- 13,600 mU/l (range 1500-141,000 mU/l; 20 mU/l = 1 microgram/l) by 37 +/- 11% after 1 week, by 49 +/- 9% after 4 weeks, and by 65 +/- 11% (n = 8) after 24 weeks of treatment. Serum prolactin was normalized in two patients. A tumor volume reduction of 20-25% was obtained in two subjects. Compared with previous treatment with oral bromocriptine the decrease in serum prolactin was comparable. In contrast, tolerance of roxindol was superior in five of seven patients with major side effects with bromocriptine, including three subjects who had discontinued bromocriptine because of adverse reactions. Four subjects spontaneously reported improvement of psychological and physical performance. One patient had a transient increase of serum transaminases. Thus, for the first time we could show a suppressive effect of roxindol on prolactin secretion in human prolactinomas. Due to its good tolerance roxindol may provide a useful alternative to bromocriptine.

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Section: Discussionsupporting

confidence: 83%

mentioning

confidence: 99%

Treatment of prolactinoma patients with the new non-ergot dopamine agonist roxindol: first results

Jaspers¹,

Benker²,

Reinwein³

1994

Clin Investig

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“…In short-term studies, pergolide has been shown to effectively lower PRL levels. In an open-label, randomized, controlled, multicenter study, Lamberts and Quik (213) reported that bromocriptine and pergolide were equally effective in lowering serum PRL levels and in inducing tumor shrinkage; a high incidence of adverse events, such as nausea, dizziness, vomiting, asthenia, headache, and decrease in blood pressure, was reported with both drugs. Data concerning the reduction of macroprolactinoma size by pergolide are limited (214 -217).…”

Section: Pergolidementioning

confidence: 99%

Advances in the Treatment of Prolactinomas

et al. 2006

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Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.

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“…Although pergolide is a potent inhibitor of prolactin secretion [27], the drug has never found an important place in the treatment of hyperprolactinaemic states. In a double-blind study involving a total of 157 hyperprolactinaemic patients the efficacy and tolerability of bromocriptine and pergolide were found to be the same, while the incidence and type of side-effects to both dopamine agonists were similar [28].…”

Section: Pergolidementioning

confidence: 96%