Obstetrics & Gynaecology/Dopamine agonist (prolactin)

Dopamine agonists (cabergoline/bromocriptine)

also: cabergoline · bromocriptine · prolactin suppression

Overview

Lower prolactin — used for lactation suppression and hyperprolactinaemia/prolactinoma (cross-references the endocrine prolactinoma card).

Mechanism

D₂ dopamine-receptor agonists act on pituitary lactotrophs — dopamine is the physiological inhibitor of prolactin, so agonism suppresses prolactin secretion (and shrinks prolactinomas).

Indications

Suppression of lactation (e.g. after stillbirth/neonatal death)
Hyperprolactinaemia / prolactinoma
Bromocriptine: also Parkinson's, acromegaly (cross-reference)

The agents

Cabergolinelong-acting D₂ agonist

twice-weekly

Preferred — better tolerated; first-line for prolactinoma + lactation suppression.

Bromocriptineergot D₂ agonist

daily

Older; more nausea; ergot fibrosis risk.

Adverse effects

Nausea, postural hypotensioncommon

Impulse-control disorders (gambling, hypersexuality)serious

Counsel; dopaminergic class effect.

Fibrosis (cardiac valvulopathy, pulmonary)serious

High-dose long-term, esp. Parkinson's dosing — echo monitoring.

Cautions & contraindications

Uncontrolled hypertension / pre-eclampsiaall

Psychotic illnessall

Cardiac valvulopathy (cabergoline, high dose)all

Interactions

Antagonised by antipsychotics / metoclopramide (dopamine antagonists raise prolactin)

Monitoring & kinetics

Prolactin levels; BP; echo if high-dose long-term

Oral. Cabergoline long half-life (twice-weekly).

Choosing it

true

Source: BNF — Dopamine-receptor agonists