Drug Action
Bromocriptine is a stimulant of dopamine receptors in the brain; it also inhibits release of prolactin by the pituitary.
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Drug reference
Bromocriptine is a stimulant of dopamine receptors in the brain; it also inhibits release of prolactin by the pituitary.
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Prevention of lactation ▶BY MOUTH ▶Adult: Initially 2.5 mg daily for 1 day, then 2.5 mg twice daily for 14 days Suppression of lactation ▶BY MOUTH ▶Adult: Initially 2.5 mg daily for 2–3 days, then 2.5 mg twice daily for 14 days Hypogonadism | Galactorrhoea | Infertility ▶BY MOUTH ▶Adult: Initially 1–1.25 mg daily, dose to be taken at bedtime, increase dose gradually; usual dose 7.5 mg daily in divided doses, increased if necessary up to 30 mg daily, usual dose in infertility without hyperprolactinaemia is 2.5 mg twice daily Acromegaly ▶BY MOUTH ▶Adult: Initially 1–1.25 mg daily, dose to be taken at bedtime, then increased to 5 mg every 6 hours, increase dose gradually Prolactinoma ▶BY MOUTH ▶Adult: Initially 1–1.25 mg daily, dose to be taken at bedtime, then increased to 5 mg every 6 hours, increase dose gradually. Occasionally patients may require up to 30 mg daily Parkinson’s disease ▶BY MOUTH ▶Adult: Initially 1–1.25 mg daily for 1 week, dose to be taken at night, then 2–2.5 mg daily for 1 week, dose to be taken at night, then 2.5 mg twice daily for 1 week, then 2.5 mg 3 times a day for 1 week, then increased in steps of 2.5 mg every 3–14 days, adjusted according to response; maintenance 10–30 mg daily
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Cardiac valvulopathy (exclude before treatment). hypertension in postpartum women or in puerperium. hypertensive disorders of pregnancy (e.g. pre-eclampsia, eclampsia or pregnancy-induced hypertension) CONTRA-INDICATIONS, FURTHER INFORMATION ▶Use in suppression of lactation or other non-life threatening indications Manufacturer advises avoid in these indications for patients with a history of severe cardiovascular conditions, including coronary artery disease, or symptoms (or history) of serious mental disorder. Very rarely hypertension, myocardial infarction, seizures or stroke (both sometimes preceded by severe headache or visual disturbances), and mental disorders have been reported in postpartum women given bromocriptine for lactation suppression—caution with antihypertensive therapy and avoid other ergot alkaloids. Discontinue immediately if hypertension, unremitting headache, or signs of CNS toxicity develop.
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Cardiovascular disease. history of peptic ulcer (particularly in acromegalic patients). history of serious mental disorders (especially psychotic disorders). Raynaud’s syndrome CAUTIONS, FURTHER INFORMATION ▶Hyperprolactinemic patients In hyperprolactinaemic patients, the source of the hyperprolactinaemia should be established (i.e. exclude pituitary tumour before treatment).
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Bromocriptine should not be used in patients with hypersensitivity to ergot alkaloids.
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FIBROTIC REACTIONS Bromocriptine has been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions. Manufacturer advises exclude cardiac valvulopathy with echocardiography before starting treatment with these ergot derivatives for Parkinson’s disease or chronic endocrine disorders (excludes suppression of lactation); it may also be appropriate to measure the erythrocyte sedimentation rate and serum creatinine and to obtain a chest X-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness. If long-term treatment is expected, then lung-function tests may also be helpful. IMPULSE CONTROL DISORDERS Treatment with dopamine-receptor agonists are associated with impulse control disorders, including pathological gambling, binge eating, and hypersexuality. Patients and their carers should be informed about the risk of impulse control disorders. Ergot- and non-ergot- derived dopamine-receptor agonists do not differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists will not control these side-effects. See Parkinson’s disease Nervous system p. 429.
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→Appendix 1: dopamine receptor agonists
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▶Common or very common Constipation. drowsiness. headache. nasal congestion. nausea ▶Uncommon Allergic dermatitis. alopecia. confusion. dizziness. dry mouth. fatigue. hallucination. hypotension . leg cramps. movement disorders. vomiting ▶Rare or very rare Abdominal pain. arrhythmias. cardiac valvulopathy. diarrhoea. dyspnoea. gastrointestinal disorders. gastrointestinal haemorrhage. neuroleptic malignant-like syndrome. pallor. paraesthesia. pericardial effusion. pericarditis. peripheral oedema. psychotic disorder. respiratory disorders. sleep disorders. tinnitus. vision disorders ▶Frequency not known Eating disorders. hypertension. myocardial infarction. pathological gambling. psychiatric disorders. seizure. sexual dysfunction. stroke SIDE-EFFECTS, FURTHER INFORMATION Treatment should be withdrawn if gastro-intestinal bleeding occurs.
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Caution—provide contraceptive advice if appropriate (oral contraceptives may increase prolactin concentration).
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Suppresses lactation; avoid breast feeding for about 5 days if lactation prevention fails.
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Dose adjustments Manufacturer advises dose adjustment may be necessary—risk of increased plasma concentration.
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▶Specialist evaluation—monitor for pituitary enlargement, particularly during pregnancy; monitor visual field to detect secondary field loss in macroprolactinoma. ▶Monitor for fibrotic disease. ▶Monitor blood pressure for a few days after starting treatment and following dosage increase. Nervous system
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Tablet CAUTIONARY AND ADVISORY LABELS 10, 21 ▶Bromocriptine (Non-proprietary) Bromocriptine (as Bromocriptine mesilate) 2.5 mg Bromocriptine 2.5mg tablets | 30 tablet P £74.99 DT = £74.99 Capsule CAUTIONARY AND ADVISORY LABELS 10, 21 ▶Parlodel (Mylan) Bromocriptine (as Bromocriptine mesilate) 5 mg Parlodel 5mg capsules | 100 capsule P £37.57 DT = £37.57 Bromocriptine (as Bromocriptine mesilate) 10 mg Parlodel 10mg capsules | 100 capsule P £69.50 DT = £69.50
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Antiparkinsonian drug therapy should never be stopped abruptly as this carries a small risk of neuroleptic malignant syndrome.
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Driving and skilled tasks Sudden onset of sleep Excessive daytime sleepiness and sudden onset of sleep can occur with dopamine-receptor agonists. Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring. Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour. Hypotensive reactions Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.
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Initially 2.5 mg daily for 1 day, then 2.5 mg twice
First-line fragment. Read the complete Indications and Dose section above.
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Initially 2.5 mg daily for 2–3 days, then 2.5 mg
First-line fragment. Read the complete Indications and Dose section above.
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Initially 1–1.25 mg daily, dose to be taken at
First-line fragment. Read the complete Indications and Dose section above.
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Initially 1–1.25 mg daily, dose to be taken at
First-line fragment. Read the complete Indications and Dose section above.
PDF page 461
Initially 1–1.25 mg daily, dose to be taken at
First-line fragment. Read the complete Indications and Dose section above.
PDF page 461
Initially 1–1.25 mg daily for 1 week, dose to be
First-line fragment. Read the complete Indications and Dose section above.
PDF page 461