The high incidence of fibrotic cardiac valvulopathies reported in association with the 8β-ergoline dopamine (DA) agonist, pergolide, and also case reports for cabergoline and bromocriptine have made it necessary to review the theoretical basis and actual findings in the case of another DA agonist, the 8α-ergoline lisuride (used since the 1970s for migraine prophylaxis as well as since the 1980s for its prolactin-lowering and anti-Parkinson activity).
We have reviewed the pharmacology of lisuride in relation to other DA agonists, and we have performed a throughout literature search as well as a search of our own and other adverse drug reaction databases for a possible relationship of lisuride with cardiac valvulopathy or for any reports of fibrosis in other locations.
Our review of the pharmacology and the literature strongly suggests that drug-induced cardiac valvulopathies are always related to a stimulatory drug effect on trophic 5-HT2B receptors. As lisuride is devoid of such an effect, but on the contrary is an extremely potent 5-HT2B antagonist, an association of lisuride therapy with cardiac valvulopathies seems to be highly unlikely. In agreement with this hypothesis, not a single report of a cardiac valvulopathy associated with lisuride therapy has been identified in any database so far.
Furthermore, against a background of an estimated 360,000 patient years, we have found only a very small number of cases of any other form of fibrosis (1× retroperitoneal, 2× pleural, 2× pulmonary, 1× interstitial pulmonary changes), in part combined with other risk factors and confounding variables. This closely matches 4 reports available from WHO (1× retroperitoneal, 3× pleural fibrosis). In addition, only 5 other possibly related conditions (3× pleural effusion, 1× pleuritis, 1× pericarditis) were identified in the lisuride adverse drug reaction database of Schering, Berlin.
No link has been found between lisuride use and fibrotic cardiac valvulopathy, in agreement with the 5-HT2B receptor antagonist effect of this drug. The very low incidence of spontaneous reports of any other fibrosis could be even compatible with an association by chance in the population exposed to lisuride. Although close monitoring for this kind of side effects is still to be recommended in the therapy with lisuride, our data do not support the concept of a class effect suggesting that all ergot-derived drugs and especially DA receptor agonists with some chemical similarity to the ergot structure will cause or facilitate cardiac valvulopathies as observed with pergolide.
From the *Global Medical Safety, Schering AG, Berlin, Germany; †Institute of Pharmacy, Free University Berlin, Germany; and ‡NeuroBiotec GmbH, Berlin, Germany.
Supported in part (preclinical data) by IBB (Investitionsbank Berlin), grant 100 21 471. Possible conflicts of interest: C.H., U.P., and R.D. are employees of Schering, which markets oral lisuride; K.P.L., D.P., and B.S. work for NeuroBiotec GmbH, Berlin, which holds the rights of parenteral forms of lisuride; and R.H. is a cofounder, shareholder, and employee of NeuroBiotec.
Reprints: C. Hofmann, Global Medical Safety, Schering AG, D-13342 Berlin, Germany (e-mail: firstname.lastname@example.org).