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Published in:

07-04-2023 | Nausea

How to manage intolerance to dopamine agonist in patients with prolactinoma

Authors: Matheo Augusto Morandi Stumpf, Felipe Moura Maia Pinheiro, Gilberto Ochman Silva, Valter Angelo Sperling Cescato, Nina Rosa Castro Musolino, Malebranche Berardo Carneiro Cunha-Neto, Andrea Glezer

Published in: Pituitary | Issue 2/2023

Abstract

Purpose

Dopamine agonists (DA) are the gold-standard for prolactinoma and hyperprolactinemia treatment. Intolerance to DA leading to drug drop out occurs in 3 to 12% of cases. We provide here a review of published data about DA intolerance and present a case report concerning the use of intravaginal cabergoline.

Methods

We review the literature on the definition, the pathogenesis, frequency and management of DA intolerance. In addition, the review provides strategies to enhance tolerability and avoid precocious clinical treatment withdrawal.

Results

Cabergoline is often cited as the most tolerable DA and its side effects tend to ameliorate within days to weeks. Restarting the same drug at a lower dose or switching to another DA can be used in cases of intolerance. The vaginal route can be tried specifically if there are gastrointestinal side effects in the oral administration. Symptomatic treatment could be attempted, although mainly based on a strategy used in other diseases.

Conclusions

Due to limited data, no guidelines have been developed for the management of intolerance in DA treatment. The most frequent management is to perform transsphenoidal surgery. Nevertheless, this manuscript provides data derived from published literature and expert opinion, suggesting new approaches to this clinical issue.

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Title: How to manage intolerance to dopamine agonist in patients with prolactinoma
Authors: Matheo Augusto Morandi Stumpf
Felipe Moura Maia Pinheiro
Gilberto Ochman Silva
Valter Angelo Sperling Cescato
Nina Rosa Castro Musolino
Malebranche Berardo Carneiro Cunha-Neto
Andrea Glezer
Publication date: 07-04-2023
Publisher: Springer US
Keywords: Nausea
Prolactinoma
Hyperprolactinemia
Dopamine Agonist
Bromocriptine
Cabergoline
Published in: Pituitary / Issue 2/2023
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-023-01313-8

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