Selective D2 dopamine agonist (non-ergot) Pregnancy: Animal data provide no evidence of embryotoxic or teratogenic potential, but experience in pregnant women is limited. In patients wishing to conceive, discontinue when pregnancy is confirmed unless there is a medical reason to continue. If pregnancy occurs in the presence of a pituitary adenoma and treatment has been stopped, close supervision throughout pregnancy is essential. Breast-feeding is usually not possible as quinagolide suppresses lactation; if lactation continues, breast-feeding cannot be recommended (§4.6).

Quinagolide

Brand names: Norprolac

Quinagolide is a non-ergot dopamine agonist used to treat hyperprolactinaemia, including that caused by prolactin-secreting pituitary tumours.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Initiate with the 'starter pack': 25 micrograms/day for the first 3 days, then 50 micrograms/day for a further 3 days; from day 7 onwards the recommended dose is 75 micrograms/day. Usual maintenance dose 75 to 150 micrograms/day

Route: Oral

Frequency: Once a day at bedtime, with some food

Source: UK SPC §4.2 for Quinagolide 25 micrograms Tablets (Norprolac). Because dopaminergic stimulation may cause orthostatic hypotension, dosage must be initiated gradually using the starter pack and given only at bedtime. The optimal dose must be titrated individually on the basis of the prolactin-lowering effect and tolerability. If necessary, the daily dose may be increased stepwise until the optimal individual response is attained. Daily doses of 300 micrograms or higher are required in fewer than one-third of patients; in such cases the daily dose may be increased in steps of 75 to 150 micrograms at intervals not shorter than 4 weeks, until satisfactory effectiveness is achieved or reduced tolerability requires discontinuation. No maximum dose is stated in this SPC. Check lying and standing blood pressure during the first days of therapy and after dose increases. Monitor for impulse control disorders; consider dose reduction or tapered discontinuation if they develop, and consider tapering on withdrawal because of dopamine agonist withdrawal syndrome. Elderly: no experience available. Children: no experience available.

Dose adjustments

Renal

Contraindicated in impaired renal function (§4.3); no data are available on use in patients with impaired renal or hepatic function (§4.4).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the drug
Impaired hepatic function
Impaired renal function
Pregnancy — see §4.6 for procedure during pregnancy

Side effects

Very common: nausea, vomiting, headache, dizziness, fatigue — predominantly in the first few days of treatment or transiently after a dose increase
Common: anorexia, abdominal pain, constipation or diarrhoea, insomnia, oedema, flushing, nasal congestion
Common: hypotension — orthostatic hypotension may cause faintness or syncope
Rare: somnolence (including reports of sudden sleep onset with dopamine agonists — patients must not drive or operate machines if affected)
Very rare: acute psychosis, reversible on discontinuation
Impulse control disorders: pathological gambling, increased libido, hypersexuality, compulsive spending or buying, binge eating and compulsive eating

Interactions

No interactions with other medicinal products have so far been reported (§4.5)
Drugs with strong dopamine antagonistic properties (e.g. neuroleptic agents) — on theoretical grounds a reduction of the prolactin-lowering effect could be expected with concomitant use

Clinical monograph

How it works

It stimulates dopamine D2 receptors on pituitary lactotroph cells, inhibiting prolactin secretion and lowering circulating prolactin concentrations.

Prescribing in practice

Initial doses can cause hypotension and dizziness, so the dose is introduced gradually, often at bedtime, to limit first-dose and postural effects.
As with other dopamine agonists, psychiatric effects and impulse-control disorders such as pathological gambling have been reported and should be asked about.
Restoration of fertility can occur as prolactin normalises, so contraceptive needs should be discussed.

Monitoring

Monitor serum prolactin to guide dosing, along with clinical assessment of symptoms and blood pressure during titration.

Counselling the patient

Take the dose as advised, usually with food at bedtime, and rise slowly to reduce dizziness.
Tell your clinician about any new urges such as gambling or compulsive behaviour.
Fertility may return as prolactin falls, so use contraception if pregnancy is not desired.

Evidence & guidelines

Quinagolide's efficacy in lowering prolactin in hyperprolactinaemia is established in the SPC and clinical use.

Reference: UK Endocrine Society; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways