Quinagolide

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.