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6.7 Other endocrine drugs

6.7.1 Dopamine Receptor Stimulants

Bromocriptine tablets, capsules
Cabergoline tablets (consultant initiation only for hyperprolactinaemia) - click here for prescribing guidance
Quinagolide tablets (consultant initiation only for hyperprolactinaemia) - click here for prescribing guidance

Notes:

1. Carbergoline appears to be an advance on bromocriptine in the treatment of patients with pathological hyperprolactineaemia. It is more effective, better tolerated and only requires once or twice weekly dosing. In view of its higher cost it should be reserved for patients who have already received bromocriptine.

2. Fibrotic reactions
Ergot-derived dopamine-receptor agonists, bromocriptine, cabergoline, lisuride [discontinued], and pergolide have been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions.

3. Exclude cardiac valvulopathy with echocardiography before starting treatment with these ergot derivatives for chronic endocrine disorders (excludes suppression of lactation) or Parkinson’s disease; it may also be appropriate to measure the erythrocyte sedimentation rate and serum creatinine and to obtain a chest X-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness. If long-term treatment is expected, then lung-function tests may also be helpful. Patients taking cabergoline or pergolide should be regularly monitored for cardiac fibrosis, by echocardiography (within 3–6 months of initiating treatment and subsequently at 6–12 month intervals).

4. Quinagolide is a non-ergot derived dopamine agonist which may be preferred for longer term use in patients with hyperprolactinaemia.
 

6.7.2 Drugs affecting gonadotrophins

Cetrorelix injection
Danazol capsules
Goserelin implant 3.6mgs, 10.8mgs.
Leuprorelin acetate, pre-filled syringe
Nafarelin nasal spray
Triptorelin - Preferred in urology as LHRH agonist of choice as available in 1,3, and 6-monthly injections

Notes:

1. Leuprorelin is available as a pre-filled syringe for IM (Prostap 3) or SC (Prostap SR, Prostap 3) administration. It can be given via a fine gauge needle and is less painful on administration compared with goserelin. Leuprorelin is the preferred gonadorelin analogue for prostate cancer.

2. Decapeptyl SR 3mg (monthly injection) is the preferred form for gynaecological indications. Gonapeptyl depot 3.75 mg (monthly) and Decapeptyl SR 11.25mg (three-monthly injection) are licensed for precocious puberty.

 

6.7.3 Metyrapone and Trilostane

Metyrapone capsules
Metyrapone is specifically included for treatment of Cushing's syndrome (specialist initiated)
Ketoconazole tablets (Cushing's syndrome)

For link to BNF section: 6.7 Other endocrine drugs