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Published: 6 June 2014

Risk of fibrosis with medicines containing ergot derivatives

Prescriber Update 35(2)
6 June 2014

Key Messages

  • Long-term use of medicines containing ergot derivatives (bromocriptine, cabergoline and ergotamine) has been associated with fibrosis.
  • Patients who need to take these medicines long-term should be monitored for the signs and symptoms of fibrosis. Treatment should be discontinued if fibrosis is diagnosed.


Ergotamine and ergot derivatives are associated with an increased risk of fibrosis, the formation of excess connective tissue.  Ergot derivatives are recognised as being capable of inducing fibrosis, particularly of the heart valves, through serotonergic receptor activation. Fibrosis is often difficult to diagnose because of delayed symptoms and may be irreversible.

Medicines containing ergotamine derivatives include: bromocriptine, cabergoline (Dostinex) and ergotamine (Cafergot).

The risk of fibrosis is greater when these medicines are used for long-term treatment such as in Parkinsons Disease (bromocriptine) and chronic endocrine disorders (bromocriptine and cabergoline). The risk of cardiac fibrosis is greatest with cabergoline and pergolide (pergolide is no longer available in New Zealand).

Since the risk of fibrosis may be related to length of use it is not thought to apply to short-term uses such as suppression of lactation or occasional use for treatment of migraine (Cafergot). However, use of Cafergot that exceeds the maximum recommended dose of 10 tablets per week, may still induce fibrotic changes. Cafergot should not be used in children under 12 years of age.

All patients who need to take ergotamine derived medicines long-term should be monitored for possible manifestations of fibrosis. Signs and symptoms include dyspnoea, persistent cough, chest pain, heart failure, renal insufficiency or urethral/abdominal obstruction.

References

  1. Pfizer New Zealand Ltd. 2013. Dostinex Data Sheet. 20 March 2013. URL: www.medsafe.govt.nz/profs/Datasheet/d/Dostinextab.pdf (accessed 1 May 2014).
  2. Apotex NZ Ltd. 2014. Apo-bromocriptine Data Sheet. 28 April 2014. URL: www.medsafe.govt.nz/profs/Datasheet/a/Apobromocriptinetab.pdf (accessed 1 May 2014).
  3. AFT Pharmaceuticals Ltd. 2014. Cafergot Data Sheet. February 2014. URL: www.medsafe.govt.nz/profs/Datasheet/c/cafergottab.pdf (accessed 1 May 2014).
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