Clinical Review#: Potential cardiac valve effects of dopamine agonists in hyperprolactinemia.

CONTEXT: An association has been demonstrated between valvular heart disease and dopamine agonist use in patients treated for Parkinson's disease. Following these reports, concern has been raised among endocrinologists about the safety of long-term treatment with dopamine agonists in hyperprolactinemic patients. The article will summarize all currently published research regarding the possible risk of valvulopathy in hyperprolactinemic patients on dopamine agonists and provide guidance based on current findings.

EVIDENCE ACQUISITION: The major source of data acquisition included PubMed search strategies. PubMed was searched for publications containing the terms "valve," "valvular," or "valvulopathy," and one of the terms "dopamine agonists," "cabergoline," "bromocriptine," "pergolide," "prolactin," "prolactinoma," or "hyperprolactinemia." All publications from 1950 to August, 2008, were screened for use in this review.

EVIDENCE SYNTHESIS: The majority of studies showed no risk of valvular regurgitation associated with cabergoline. However, an increased risk of mild to moderate regurgitation, usually at the tricuspid valve, was reported in a few studies. Only one study suggested a relationship with the mean cumulative dose of cabergoline.

CONCLUSIONS: Although most reports do not show an association between use of dopamine agonists and valvulopathy, caution must be exercised, especially in patients requiring long-term, high-dose medication regimens. Clinicians should recommend the lowest possible doses of dopamine agonists and address the question of echocardiographic monitoring on an individual basis.