Bromocriptine

Indications

Bromocriptine is used for: Parkinson's disease, Galactorrhoea, Hypogonadism, Infertility, acromegaly, Lactation suppression, benign breast and menstrual disorders, Amenorrhea, hyperprolactinaemia .

Adult Dose

Adult: PO Parkinson's disease As adjunct to levodopa: 1st wk: 1-1.25 mg at night, 2nd wk: 2-2.5 mg at night; 3rd wk: 2.5 mg twice daily; 4th wk: 2.5 mg 3 times/day, then increase as needed. Maintenance: 10-40 mg/day. Hyperprolactinemia Initial: 1.25-2.5 mg PO qDay May increase by 2.5 mg/day q2-7Days Usual therapeutic dosage 5-7.5 mg/day, ranges from 2.5-15 mg/day Up to 30 mg/day has been used in some patients with amenorrhea &/or galactorrhea Acromegaly (Parlodel) 1.25-2.5 mg PO qHS for 3 days May increase by 1.25-2.5 mg/day at q3-7Days Not to exceed 100 mg/day Adjunct to surgery and radiotherapy in patients w/ acromegaly Initial: 2.5 mg twice daily, increase slowly, up to 5 mg 6 hrly if needed. Lactation suppression 2.5 mg/day for 2-3 days, up to 2.5 mg twice daily for 14 days. Prevention of puerperal lactation 2.5 mg on the day of delivery, then 2.5 mg twice daily for 14 days. Cyclical benign breast and menstrual disorders 2.5 mg twice daily. Hepatic Impairment: Dose adjustment may be necessary; there are no guidelines

Child Dose

Hyperprolactinemia 11-15 years: 1.25-2.5 mg PO qDay (initially) Maintenance: 2.5-10 mg/day

Renal Dose

Administration

Should be taken with food.

Contra Indications

Breast carcinoma, hypersensitivity to ergot alkaloids, uncontrolled hypertension, severe ischaemic heart disease. Pregnancy and lactation.

Precautions

Increased risk of conception, patients with peptic ulcer, diabetes, diabetic retinopathy, impaired hepatic or renal function, pleuropulmonary signs and symptoms, history of psychosis, CV disease, dementia or concurrent antihypertensive therapy, ability to drive vehicles or operating machinery may be impaired. Lactation: should not be used during lactation

Pregnancy-Lactation

Pregnancy Safety of Bromocriptine treatment during pregnancy to the mother and fetus has not been established If pregnancy occurs during Bromocriptine administration, careful observation of these patients is mandatory Prolactin-secreting adenomas may expand and compression of optic/other cranial nerves may occur, emergency pituitary surgery becoming necessary; in most cases, the compression resolves following delivery Reinitiation of Bromocriptine treatment has been reported to produce improvement in the visual fields of patients in whom nerve compression has occurred during pregnancy In patients being treated for hyperprolactinemia, Bromocriptine should be withdrawn when pregnancy is diagnosed Acromegaly, prolactinoma, or Parkinson disease Patients who subsequently become pregnant, determine whether continuing therapy is medically necessary or can discontinues If it is continued, discontinue therapy in those who may experience hypertensive disorders of pregnancy (including eclampsia, preeclampsia, or pregnancy-induced hypertension) unless withdrawal of Bromocriptine is considered to be medically contraindicated Lactation Avoid use during lactation in postpartum women

Interactions

Bioavailability increased if given along with erythromycin. Alcohol reduces tolerance to bromocriptine and vice-versa. Effects of antihypertensives may be potentiated. Avoid concurrent psychotropics.

Adverse Effects

Side effects of Bromocriptine : >10% Nausea (49%), Hypotension (30%), Headache (19%), Dizziness (17%) 1-10% Abdominal cramps, Anorexia, Constipation, Dyspepsia, Dysphagia, Epigastric pain, GI hemorrhage, Vomiting, Drowsiness, Fatigue, Faintness, Hallucinations Visual, Insomnia, Lightheadedness, Nighmares, Paranoia, Psychosis, Seizure, Vertigo, Arrhythmias, Bradycardia, Hypertension, MI, Mottled skin, Orthostasis, Vasospasm, Palpitations, Pericardial effusions, Raynaud's syndrome exacertabtion, Syncope, Blepharospasm, BUN increased, Burning discomfort of the eye, Diplopia, Facial pallor, Leg cramps, Nasal congestion, Rash, Urticaria

Mechanism of Action

Bromocriptine is a dopamine D2 and D3-agonist which works by activating postsynaptic dopamine receptors in the tuberoinfundibular and nigrostriatal pathways. It also inhibits the secretion of prolactin from the anterior pituitary and is used in the treatment of prolactinoma and in endocrinological disorders.