The responsibility for undertaking these tests may vary depending on local agreements between primary and secondary care.

• Ergot-derived dopamine agonists (bromocriptine, cabergoline, pergolide) can rarely cause fibrotic reactions, including lung and heart-valve fibrosis, cardiac valve thickening, and reddening of the legs.
• At baseline, erythrocyte sedimentation rate and serum creatinine should be measured and chest radiography obtained.
• During treatment, people taking an ergot-derived dopamine agonist should be monitored for signs and symptoms of pleuro-pulmonary disease (such as shortness of breath, persistent cough, and chest pain) and retroperitoneal disorders. Renal insufficiency or ureteric or abdominal vascular obstruction might occur, with pain in the loin or flank and leg oedema. Abdominal masses or tenderness could suggest retroperitoneal fibrosis.
• Echocardiography should be done before treatment with cabergoline or pergolide to exclude cardiac valvulopathy.
• Echocardiography should also be done within 3–6 months of starting treatment, and subsequently at 6–12 month intervals. Treatment should be stopped if an echocardiogram shows new or worsened valvular regurgitation, valvular restriction, or valve-leaflet thickening [CSM, 2002; CSM, 2003; National Collaborating Centre for Chronic Conditions, 2006; MHRA, 2007; MHRA, 2008].
• Tolcapone has (rarely) caused fulminant hepatic failure. Liver function should be checked before starting treatment with tolcapone and then monitored every 2 weeks for the first year of therapy, every 4 weeks for the next 6 months, and every 8 weeks thereafter [ABPI Medicines Compendium, 2009]. However, such monitoring will not always predict the development of severe hepatic disease [CSM, 1999], and people using tolcapone should be asked to report any signs or symptoms of liver disease (such as yellowing of the skin or eyes).
• Entacapone does not seem to cause hepatic problems, and monitoring of liver function tests is not required.
• Apomorphine's summary of product characteristics states that people using apomorphine with levodopa should have regular haematological monitoring (for example, every 6 months) to detect rare instances of haemolytic anaemia [ABPI Medicines Compendium, 2008a]. There is no need to do this if a person using apomorphine does not use levodopa (even if they are taking other drugs to treat Parkinson's disease) [American Medical Directors Association, 2002; Goetz et al, 2002].