Severe multivalvular heart disease: A new complication of the ergot derivative dopamine agonists

Horváth, Judit; Fross, Robin D.; Kleiner‐Fisman, Galit; Lerch, René; Stalder, Hans; Liaudat, Suzanne; Raskoff, William J.; Flachsbart, Keith; Rakowski, Harry; Pache, Jean–Claude; Burkhard, Pierre; Lang, Anthony E.

doi:10.1002/mds.20201

Cited by 224 publications

(135 citation statements)

References 15 publications

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“…Activation of these receptors might lead to mitogenesis and fibroblast proliferation. Histopathological investigations of cardiac valves obtained from patients after treatment with pergolide or cabergoline for Parkinson's disease resemble the histological abnormalities observed in the valves from patients with carcinoid disease and from patients taking antimigraine ergot alkaloid drugs (ergotamine, methysergide) or anorectic drugs (fenfluramine) (3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 80%

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Kars

Pereira²,

Bax³

et al. 2008

European Journal of Endocrinology

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The increased risk of cardiac valve disease in patients treated for Parkinson's disease with cabergoline has raised concerns about the safety of treatment with ergot-derived dopamine agonists in patients with endocrine diseases, especially prolactinoma. Six cross-sectional studies have been published recently, of which five studies do not show an association between the treatment of prolactinoma with cabergoline during 45-79 months and clinically relevant valvular regurgitation in a total of 413 patients. Nonetheless, concern is raised because the use of cabergoline was associated in one study with an increased prevalence of moderate tricuspid regurgitation, and in two other studies with mild tricuspid regurgitation. Furthermore, the use of cabergoline was associated with increased frequencies of valvular thickening, calcifications and increased mitral tenting area. At present, the clinical relevance of these findings is still uncertain, but concern is raised with respect to the safety of the use of cabergoline in the long-term treatment of prolactinomas. Echocardiographic evaluation should be considered in patients, who require long-term treatment with cabergoline, especially in high doses. There is a need for larger, preferably prospective, studies with careful echocardiographic assessment and with longer durations of follow-up than the currently available studies.

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Section: Introductionmentioning

confidence: 80%

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Kars

Pereira²,

Bax³

et al. 2008

European Journal of Endocrinology

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“…Several cross-sectional studies have demonstrated a significantly increased risk of valvular fibrosis in Parkinson's patients treated with the ergot-derived dopamine agonists (DAs) pergolide and cabergoline (1,2,3,4,5,6). Extensive research over the last decade has highlighted the crucial role of 5-hydroxytryptamine 2B receptors (HTR2B) in the pathogenesis of this fibrotic valvular heart disease (FVHD) (7).…”

Section: Introductionmentioning

confidence: 99%

Increased prevalence of subclinical cardiac valve fibrosis in patients with prolactinomas on long-term bromocriptine and cabergoline treatment

Еленкова¹,

Shabani

Kalinov

et al. 2012

European Journal of Endocrinology

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Background: In contrast to cabergoline, evidence-based information about a possible profibrotic effect of bromocriptine in prolactinoma patients is extremely limited. Objective: To assess the prevalence of valvular lesions among patients on long-term bromocriptine or cabergoline therapy. Design: Case-control study. Methods: A transthoracic echocardiographic evaluation was performed in 334 subjects divided into four groups: 103 cabergoline treated, 55 bromocriptine treated, 74 naïve patients, and 102 controls. Results: Clinically relevant valve regurgitations were equally prevalent in all investigated groups whereas subclinical valve fibrosis was significantly more frequent in both bromocriptine-and cabergoline-treated patients (40 vs 43.6 vs 21.6 vs 23.5%; PZ0.004). The odds ratio (OR) for developing valvular fibrosis was 2.27 (95% CI 1.17-4.41; PZ0.016) for cabergoline and 2.66 (95% CI 1.22-5.78; PZ0.014) for bromocriptine groups compared with subjects not exposed to dopamine agonists (DAs). A significantly higher pulmonary arterial pressure corresponding to the longer treatment duration was observed among patients taking bromocriptine compared with cabergolinetreated subjects. Conclusions: Long-term treatment with cabergoline and bromocriptine seems not to be associated with an increased risk of clinically significant valve disease but possible subclinical lesions should be expected. An echocardiographic examination is recommended at the beginning and periodically during therapy with DAs acting as full or partial agonists of 5-hydroxytrytamine 2B receptors (cabergoline and bromocriptine). Bromocriptine seems not to be a safe alternative for patients receiving cabergoline treatment who have preexisting or diagnosed abnormalities suggesting valvular, interstitial myocardial, or pulmonary fibrosis. Further studies are needed to investigate the possible impact of DA treatment on pulmonary arterial pressure.

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“…An [ 123 I]␤-CIT single-photon emission computed tomography (SPECT) substudy 19 included 142 subjects where a scan was completed at baseline and week 40. The clinical results demonstrated that LD improved PD in a dose-response pattern beginning at week 9 through the last treatment visit, compared with placebo.…”

Section: Dopamine Precursor Therapy: Levodopamentioning

confidence: 99%

Current Status of Symptomatic Medical Therapy in Parkinson’s Disease

Factor

2008

Neurotherapeutics

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Summary: Symptomatic medical therapies for Parkinson's disease (PD) have been disease modifying and have led to improvement in daily function, quality of life, and survival. For 40 years, these therapies have been primarily dopaminergic, and currently include the dopamine (DA) precursor levodopa (LD), DA agonists, catechol-O-methyltransferase (COMT) inhibitors, and monoamine oxidase (MAO) inhibitors. The roles of all these classes of agents have evolved, with significant changes occurring since the early 2000s. This article reviews the current literature for each of these classes of drugs, with a focus on efficacy and place in the therapeutic scheme. Levodopa is no longer considered to be toxic and, thus, its early use is not only appropriate but recommended.Ergot agonists are no longer in use, and new agents administered in patch form or subcutaneous injections have been approved. The COMT inhibitor tolcapone, with its significant efficacy, has been reintroduced, and two new MAO inhibitors have been approved. Selected safety issues are discussed, including the incidence of melanoma in relation to LD; pathological gambling and DA agonists; hepatic toxicity of tolcapone; and the tyramine or so-called cheese reaction with MAO B inhibitors. The article closes with a discussion of future directions and new drugs under development.

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Severe multivalvular heart disease: A new complication of the ergot derivative dopamine agonists

Cited by 224 publications

References 15 publications

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Cabergoline and cardiac valve disease in prolactinoma patients: additional studies during long-term treatment are required

Increased prevalence of subclinical cardiac valve fibrosis in patients with prolactinomas on long-term bromocriptine and cabergoline treatment

Current Status of Symptomatic Medical Therapy in Parkinson’s Disease

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