Doctors Lounge - Endocrinology Answers
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Forum Name: Endocrinology Topics
|Punch - Mon Jan 30, 2006 3:49 pm||
Following Hormone tests and an MRI scan my wife has been diagnosed with a macroprolactinemia, the tumor is a good 3mm away from the optic chiasm. She is not expeiencing any visualsymptoms or headaches. The Endocrinology Specialist intends prescribing Bromocryptine in the first instance.
My wife and I have done some reading, and we have read that Cabergoline may be a more effective drug with fewer side effects.
Could anyone help us understand if there is any medical ground that would influence the choice of Bromocryptine over Cabergoline by the specialist. If not what would be the reason behind their choice?
Kind thanks for any help with this, we really appreciate it.
|Dr. Shank - Wed Feb 01, 2006 4:53 pm||
Assuming that your wife is not pregnant (a fairly safe assumptin, with a macroprolactinoma) or attempting to become pregnant, there is no medical reason for chosing bromocriptine over cabergoline. Period. The ONLY reason someone MIGHT prefer to use bromocriptine during pregnancy is that, as a much older drug, it has been used in pregancy more often, so we are a little more sure that it is safe. Having said that, the last I reviewed this topic, there was a significant body of medical literature showing cabergoline to be safe during pregnancy, so even that is a questionable reason to chose bromocriptine.
So long as pregancy is not an issue and cabergoline is available to you in England, the only other rationale for bromocriptine over cabergoline would be cost. While the cost per pill is very high for cabergoline (best prices in the U.S. $30-40), I have patients who take 1/2 pill once or twice a week, which makes it cost competitive with bromocriptine at U.S. prices. Since cabergoline is far more effective and much better tolerated than bromocriptine, if it were my wife, I would try to obtain the cabergoline, even if I had to pay the difference in cost. My patients who think that they will save money on bromocriptine eventually come back and ask to switch back to cabergoline!
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