How to manage intolerance to dopamine agonist in patients with prolactinoma
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..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Pituitary - 26(2023), 2 vom: Apr., Seite 187-196 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Stumpf, Matheo Augusto Morandi [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Bromocriptine |
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| Anmerkungen: |
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
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| doi: |
10.1007/s11102-023-01313-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
OLC2143744749 |
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| 520 | |a 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. | ||
| 650 | 4 | |a Prolactinoma | |
| 650 | 4 | |a Hyperprolactinemia | |
| 650 | 4 | |a Cabergoline | |
| 650 | 4 | |a Bromocriptine | |
| 650 | 4 | |a Dopamine agonist | |
| 650 | 4 | |a Intolerance | |
| 650 | 4 | |a Corticosteroid | |
| 700 | 1 | |a Pinheiro, Felipe Moura Maia |4 aut | |
| 700 | 1 | |a Silva, Gilberto Ochman |4 aut | |
| 700 | 1 | |a Cescato, Valter Angelo Sperling |4 aut | |
| 700 | 1 | |a Musolino, Nina Rosa Castro |0 (orcid)0000-0003-1562-4476 |4 aut | |
| 700 | 1 | |a Cunha-Neto, Malebranche Berardo Carneiro |4 aut | |
| 700 | 1 | |a Glezer, Andrea |0 (orcid)0000-0002-8201-6756 |4 aut | |
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