Used less frequently today as longer-acting dopamine agonists are available. Important to monitor for moderate to severe cardiac valvulopathy and serosal fibrosis (pleural, pericardial, and retroperitoneal). Regularly check ESR, U&E, and CXR.
About
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- Short-acting dopamine agonist used in various endocrine and neurological conditions.
Action
- Dopamine Agonism: Stimulates D2 receptors in the CNS.
- Prolactin Inhibition: Dopamine inhibits prolactin release, useful in hyperprolactinemia-related conditions.
Indication/Dose
- Suppression/Prevention of Lactation: Bromocriptine 2.5 mg twice daily for 14 days.
- Hyperprolactinemia: Start with 1.25 mg/day, gradually increasing to 2.5-15 mg daily with very slow dose adjustments.
- Acromegaly: Begin at 1.25 mg/day, increasing gradually to a maximum of 30 mg/day as tolerated.
- Parkinson’s Disease: Start at 1.25 mg/day, with gradual increases to a maximum of 2.5-30 mg/day as required.
Interactions
- Increased Bromocriptine Toxicity: Concurrent use with macrolides (Clarithromycin, Erythromycin) can increase bromocriptine levels and toxicity.
Cautions
- Drowsiness: May be sudden; patients should be cautioned about driving or operating heavy machinery.
- Raynaud’s Phenomenon: Bromocriptine may worsen symptoms; use with caution.
- Acute Porphyria: Risk of exacerbation in susceptible individuals.
- Impulse Control Disorders: Monitor for unusual behaviors such as gambling, hypersexuality, or compulsive shopping.
Contraindications
- Preeclampsia and Postpartum Hypertension: Contraindicated due to risk of worsening these conditions.
- Hypersensitivity to Ergot Derivatives: Do not use in individuals with known allergies to ergot-based drugs.
Side Effects
- Gastrointestinal: Nausea, vomiting, constipation, diarrhoea.
- Neurological: Dizziness, fatigue, drowsiness, headache, confusion, delirium.
- Cardiovascular: Postural hypotension, digital vasospasm, risk of neuroleptic malignant syndrome on abrupt withdrawal.
- Fibrotic Reactions: Constrictive pericarditis, pulmonary and retroperitoneal fibrosis. Regular monitoring with ESR, U&E, and CXR recommended.
- Behavioral Changes: Impulse control disorders, such as compulsive behaviors and hypersexuality.