Pergolide Linked to Valvular Disease

Laurie Barclay, MD

December 10, 2002

Dec. 10, 2002 — Three cases reported in the December issue of the Mayo Clinic Proceedings suggest to investigators that all patients being treated with pergolide should be evaluated with echocardiogram for valvular disease, and that the drug should be discontinued if the echo shows valvular lesions without other etiology. The editorialist offers a perspective on these cases, which are disquietingly reminiscent of the fenfluramine/dexfenfluramine story.

"The clinical, echocardiographic and pathologic findings in our three patients suggest that pergolide treatment may cause valvular disease," senior author Raul Espinosa, MD, from the Mayo Clinic in Rochester, Minnesota, says in a news release.

These women, ages 61, 72 and 74 years, receiving long-term pergolide therapy for Parkinson's disease or restless legs syndrome, had valvular abnormalities strikingly similar to those induced by fenfluramine, ergot derivatives, or carcinoid. All three had severe, unexplained tricuspid regurgitation; two had predominantly right-sided congestive heart failure; and two had moderate aortic and mitral valve regurgitation. Histology revealed surface fibroproliferative lesions with preserved underlying valve architecture. Carcinoid was excluded, and none of the patients had taken anorectic drugs or ergots other than pergolide.

Although the authors recommend that patients discontinue taking pergolide if valvular disease is detected without any other cause, they acknowledge that more studies are needed to determine the incidence of valvular disease and the spectrum of abnormalities seen with pergolide treatment.

In an accompanying editorial, Shahbudin H. Rahimtoola, MB, FRCP, from the University of Southern California in Los Angeles, recommends that a well-designed prospective study be conducted at three to four medical centers with experienced cardiologists and advanced laboratories and equipment. Testing should include clinical cardiac evaluation and two-dimensional echocardiographic and Doppler studies.

"Is the association with use of the drug real? Yes, until proven otherwise," Dr. Rahimtoola says. "One could argue that this is a report of only three patients and that we should wait for more cases; however, try telling that to patients and families of those who subsequently develop valvular heart disease that requires valve replacement."

Mayo Clin Proc. 2002;77:1275-1277, 1280-1286

Reviewed by Gary D. Vogin, MD