Quinagolide – a valuable treatment option for hyperprolactinaemia

Abstract

Hyperprolactinaemia is characterised by gonadal dysfunction, including infertility and reduced libido and, if left untreated, is associated with an increased risk of long-term complications, such as osteoporosis. The first-line therapy for patients with hyperprolactinaemia is pharmacological intervention with a dopamine agonist. Currently, there are three dopamine agonists available for hyperprolactinaemia therapy: bromocriptine, quinagolide and cabergoline. Bromocriptine has a long history of use; however, a range of 5-18% of patients are reported to show bromocriptine resistance, with only partial lowering of plasma prolactin levels and an absence of tumour shrinkage. The newer dopamine agonists, quinagolide and cabergoline, offer improved efficacy over bromocriptine, with a lower incidence of adverse events. Quinagolide and cabergoline have also demonstrated efficacy in many patients intolerant or resistant to bromocriptine. Thus, the selection of dopamine agonists available provides more than one option for pharmacological intervention of hyperprolactinaemia. This review discusses the clinical use of quinagolide in comparison to other dopamine agonists for hyperprolactinaemia therapy. Quinagolide may improve patient compliance to treatment owing to its reduced side effect profile, simple and rapid titration over just 7 days, once-daily dosing regimen and easy to use starter pack (available in some countries). Quinagolide offers an additional benefit for patients wishing to become pregnant, as it can be used until the point of confirmation of pregnancy. Therefore, as a well tolerated and effective therapy, with a simple dosing regimen, quinagolide should be considered as a first-line therapy in the treatment of hyperprolactinaemia.

Cabergoline and the risk of valvular lesions in endocrine disease.

“…Bromocriptine is less well tolerated and has an unfavorable dosing regimen when compared with cabergoline. A role for non-ergot/ ergoline dopamine agonists has been less thoroughly validated in the treatment of hyperprolactinemia, although data on quinagolide are available (22). The risk-benefit ratio for surgery or radiotherapy for the treatment of all but the largest and most resistant prolactinomas would appear to be relatively unfavorable.…”

Female infertility and endocrinological diseases

“…Kabergolin bromokriptinle kıyaslandığında daha etkilidir ve daha az yan etki görülür. Quinagolide de kabergolin kadar etkili ve güvenlidir [11]. Bromokriptin ve kabergolin gebelik planlayan hastalarda daha rahat kullanılabilirken Quinagolide hakkında yeterli veri olmadığından gebelik planlayan hastalarda kullanımında dikkat edilmelidir.…”

Functioning Pituitary Adenoma

“…When comparing the plasma half-life, efficacy and tolerability of these drugs, cabergoline seems to have the most favorable profile, followed by quinagolide (16). As a well tolerated and effective therapy and a simple dosing regimen, quinagolide (selective D2 receptor agonist) can also be considered a first-line therapy in the treatment of hyperprolactinaemia (19). Pergolide (a D1 and D2 agonist) normalizes prolactin excess and reduces tumor size in recently diagnosed patients with macroprolactinomas with a potency of about 100-fold that of bromocriptine (20).…”

“…Medical and surgical therapies generally have excellent results, and most prolactinomas are well controlled or even cured in some cases (19). Dopamine agonists are the preferred therapy for prolactinomas because of the risk of recurrent hyperprolactinemia that accompanies transsphenoidal surgery (25,26).…”