Drugs List

Therapeutic Indications

Uses

Hyperprolactinaemia
Prolactinoma

Administration

To be taken orally with some food at bedtime.

Contraindications

Children under 18 years
Breastfeeding
Galactosaemia
Hepatic impairment
Pregnancy

Precautions and Warnings

Elderly
Glucose-galactose malabsorption syndrome
History of psychosis
Lactose intolerance
Postural hypotension
Psychosis
Renal impairment

Advise hypotension may initially affect ability to drive/operate machinery
Advise patient somnolence may affect ability to drive or operate machinery
Contains lactose
Monitor blood pressure during titration and early maintenance treatment
Monitor patients for impulse control disorders
Review treatment if impulse control disorders symptoms occur
Discontinue if psychiatric disturbances develop
Dopamine agonists have been associated with pathological gambling
Pregnancy confirmed: Discontinue this medication
Female: Barrier or non-hormonal contraception required during treatment
Advise patient/carer about symptoms of impulse control disorders

Postural hypotension may result in syncope. Monitor blood pressure, both lying and standing, during titration and early maintenance treatment.

Pregnancy and Lactation

Pregnancy

Quinagolide is contraindicated in pregnancy.

Data from animal studies does not indicate any teratogenic or embryotoxic potential, however experience with pregnant women is limited. Patients wishing to conceive should discontinue treatment once pregnancy is confirmed, unless there is a medical reason for continuing treatment. No increased incidence of abortion has been observed when treatment is discontinued at this point.

If pregnancy occurs in the presence of a pituitary adenoma and treatment has been stopped, close supervision is required throughout pregnancy.

There are limited cases of quinagolide used throughout pregnancy, however, no abnormal outcomes have been noted (Schaefer, 2007).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Quinagolide is contraindicated in breastfeeding.

Breastfeeding is not usually possible during treatment with quinagolide, however if lactation should continue, breastfeeding is not recommended. It is not known whether quinagolide is secreted in human breast milk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Anorexia
Constipation
Diarrhoea
Dizziness
Faintness
Fatigue
Fluid retention
Flushing
Headache
Hypersexuality
Hypotension
Increased libido
Insomnia
Nasal congestion
Nausea
Pathological gambling
Psychotic episodes
Somnolence
Sudden sleep onset episodes
Syncope
Vomiting

Presentation

Tablets containing quinagolide

Drugs List

Therapeutic Indications

Uses

Hyperprolactinaemia
Prolactinoma

Dosage

Optimal dose should be titrated individually based on the prolactin-lowering effect and the patient's tolerance of therapy.

Adults

Patients with Renal Impairment

Administration

To be taken orally with some food at bedtime.

Contraindications

Children under 18 years
Breastfeeding
Galactosaemia
Hepatic impairment
Pregnancy

Precautions and Warnings

Elderly
Glucose-galactose malabsorption syndrome
History of psychosis
Lactose intolerance
Postural hypotension
Psychosis
Renal impairment

Advise hypotension may initially affect ability to drive/operate machinery
Advise patient somnolence may affect ability to drive or operate machinery
Contains lactose
Monitor blood pressure during titration and early maintenance treatment
Monitor patients for impulse control disorders
Review treatment if impulse control disorders symptoms occur
Discontinue if psychiatric disturbances develop
Dopamine agonists have been associated with pathological gambling
Pregnancy confirmed: Discontinue this medication
Female: Barrier or non-hormonal contraception required during treatment
Advise patient/carer about symptoms of impulse control disorders

Postural hypotension may result in syncope. Monitor blood pressure, both lying and standing, during titration and early maintenance treatment.

Pregnancy and Lactation

Pregnancy

Quinagolide is contraindicated in pregnancy.

Data from animal studies does not indicate any teratogenic or embryotoxic potential, however experience with pregnant women is limited. Patients wishing to conceive should discontinue treatment once pregnancy is confirmed, unless there is a medical reason for continuing treatment. No increased incidence of abortion has been observed when treatment is discontinued at this point.

If pregnancy occurs in the presence of a pituitary adenoma and treatment has been stopped, close supervision is required throughout pregnancy.

There are limited cases of quinagolide used throughout pregnancy, however, no abnormal outcomes have been noted (Schaefer, 2007).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Quinagolide is contraindicated in breastfeeding.

Breastfeeding is not usually possible during treatment with quinagolide, however if lactation should continue, breastfeeding is not recommended. It is not known whether quinagolide is secreted in human breast milk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Anorexia
Constipation
Diarrhoea
Dizziness
Faintness
Fatigue
Fluid retention
Flushing
Headache
Hypersexuality
Hypotension
Increased libido
Insomnia
Nasal congestion
Nausea
Pathological gambling
Psychotic episodes
Somnolence
Sudden sleep onset episodes
Syncope
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: December 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. Accessed on 11 December 2014.

Summary of Product Characteristics: Norprolac Tablets 25, 50 and 75 micrograms. Ferring Pharmaceuticals Ltd. Revised April 2013.

The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.