BMA Concise Guide to Medicine & Drugs

Bromocriptine

Brand name Parlodel

Used in the following combined preparations None

QUICK REFERENCE

Drug group Drug for parkinsonism and pituitary agent

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Bromocriptine stimulates dopamine receptors in the brain, causing a reduction in the secretion of the hormone prolactin from the pituitary gland. Hence it is used in the treatment of conditions associated with excessive prolactin production, such as some types of female infertility and, occasionally, male infertility. It is also used to reduce the size of prolactin-secreting tumours in the brain, and may be used to suppress lactation in women who do not wish to breast-feed.

Bromocriptine may also be used to treat Parkinson’s disease, especially when the disease is not controlled by levodopa. Bromocriptine also reduces the release of growth hormone and can therefore be used to treat acromegaly.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, capsules.

Frequency and timing of doses 1–4 x daily with food.

Adult dosage range The dose given depends on the condition being treated and your response. In most cases treatment starts with a daily dose of 1–1.25mg. This is gradually increased until a satisfactory response is achieved.

Onset of effect Variable depending on the condition.

Duration of action 8–12 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. If you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Adverse effects such as nausea, vomiting, and constipation are usually dose-related. When used to treat Parkinson’s disease, bromocriptine may cause abnormal movements. If the drug causes such movements or produces confusion, dizziness, headache, sudden drowsiness, palpitations, or breathlessness, you should consult your doctor. Rarely, bromocriptine may cause hypersexuality and behavioural problems, such as compulsive gambling; if so, discuss with your doctor. When bromocriptine is used for long periods, there is a small risk of fibrosis (see Prolonged use).

INTERACTIONS

Antipsychotic drugs oppose the action of bromocriptine and increase the risk of parkinsonism.

Phenylpropanolamine, ephedrine, and pseudoephedrine These drugs are found in some over-the-counter cough and cold remedies. Use of these with bromocriptine may lead to severe adverse effects.

Erythromycin and other macrolide antibiotics These drugs may lead to increased levels of bromocriptine and the risk of adverse effects.

Domperidone and metoclopramide These drugs may reduce some of the effects of bromocriptine.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a history of peptic ulcers.

· You have a history of psychiatric disorders.

· You have high blood pressure.

· You have porphyria.

· You have heart disease.

· You have liver disease.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug suppresses milk production, and prevents it completely if given within 12 hours of delivery. If you wish to breast-feed, consult your doctor.

Infants and children Not usually prescribed under 15 years.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how bromocriptine affects you because the drug may cause dizziness and drowsiness.

Alcohol Avoid. Alcohol increases the likelihood of confusion and reduces tolerance to bromocriptine.

PROLONGED USE

Rarely, long-term use is associated with fibrosis (thickening of connective tissue) of the heart valves, lungs, and lining of the chest and abdominal cavities.

Monitoring Periodic blood tests may be performed to check hormone levels. To check for fibrosis echocardiography should be performed before starting treatment and at regular intervals during the treatment. Other tests, such as lung function tests, kidney function tests, or kidney scans, may also be carried out.