Bromocriptine

Indications & Dose:

Hyperprolactinemia-associated dysfunctions (including amenorrhea with or without galactorrhea, infertility, or hypogonadism); prolactin-secreting adenomas (may be used to reduce the tumor mass prior to surgery); female infertility associated with hyperprolactinemia; acromegaly; Parkinson’s disease; prevention of physiological lactation* (after parturition when the mother elects not to breast-feed the infant, when breast feeding is contraindicated, after stillbirth or abortion); neuroleptic malignant syndrome,* cocaine addiction; cyclic mastalgia
DOSE

Adults: Initially 1mg-1.25mg at bedtime. Titrate gradually at 2 to 3 days intervals to 7.5mg daily in divided doses with meals. max. 30mg daily.

Prevention of lactation: Initially 2.5mg on day of delivery then 2.5 mg twice daily with meals for 14 days.

Suppression of lactation: Initially 2.5mg on the first day increasing after two to three days to 2.5mg twice daily with meals for 14 days.

Hyperprolactinaemia: Initially 1mg-1.25mg at night. Titrate graduatly at 2 to 3  days intervales to 5mg daily in divided doses with meals upto 30mg daily.

Benign breast disease and mastalgia:  Initially 1mg1.25mg at night, titrate gradually to 2.5mg twice daily with meals.   Adjunct in acromegaly, prolactinomas: Initially 1mg-1.25mg at night. Titrate gradually at 2 to 3 days intervals to 5mg six hourly with meals.

Parkinsonism:  Week 1: 1mg-1.25mg at bed time. Week 2: 2mg-2.5mg 3 times daily increased further at 3 to 14 day intervals in increments of 2.5mg to 10-40mg daily in three divided doses. All doses should be taken during meals.

Children: Not recommended. 

Contraindications:

Severe ischemic disease uncontrolled hypertension, toxemia of pregnancy, sensitivity to any ergot alkaloids, severe peripheral vascular disease. Pregnancy & breast-feeding. 

Side Effects:

CNS: Abnormal involuntary movements, anxiety, ataxia, cerebrospinal fluid rhinorrhea (treatment of prolactinomas), confusion, depression, dizziness, drowsiness, fatigue, hallucinations, headache, insomnia, nervousness, “on-off” phenomenon, psychosis, restlessness, seizures, visual disturbance

CV: Bradycardia, decreased BP, dysrhythmias, extrasystole, orthostatic hypotension, palpitation, shock, stroke

EENT: Blurred vision, burning eyes, diplopia, nasal congestion

GI: Anorexia, constipation, cramps, diarrhea, dry mouth, GI hemorrhage, nausea (49%), vomiting

GU: Diuresis, frequency, incontinence, retention

SKIN: Alopecia, rash on face, arm

Cautions:

Precautions:

Hepatic disease, renal disease, children, pituitary tumors, hypotension, concurrent BP-lowering medications

Old age: May be used. 

Interaction:

Drugs

Erythromycin: Marked elevations in bromocriptine levels

Isometheptene: Case report of hypertension and ventricular tachycardia with combination

Neuroleptics: Neuroleptic drugs probably inhibit the ability of bromocriptine to lower serum prolactin concentrations in patients with pituitary adenomas; theoretically, brornocriptine should inhibit the antipsychotic effects. of neuroleptic agents, but clinical evidence suggests that this may be uncommon

Phenylpropanolamine: Increased risk of hypertension and seizures 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: