Fibrosis due to ergot derivatives: exposure to risk should be weighed up

(1) Ergot derivatives are used for a variety of indications, including migraine, Parkinson's disease, endocrine disorders, and cognitive and neurosensory deficits in elderly people. (2) Fibrosis is a common complication of treatment with ergot derivatives. (3) Retroperitoneal fibrosis is the commonest form. Pleuropulmonary and pericardial fibrosis also occur. (4) Cardiac valve damage has been linked to some ergot derivatives. (5) Fibrosis occurs during long-term treatment. (6) Renal, pulmonary and cardiac complications can be serious. The fibrosis is often reversible if the drug is stopped quickly. (7) In practice, this risk of serious adverse effects tips the scales against these drugs for poorly established indications such as cognitive and neurosensory deficits in elderly people. The possibility of drug induced fibrosis should be considered at the first sign of renal, cardiac or pulmonary fibrosis in a patient on ergot derivatives.