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NERVOUS SYSTEM › ANTI-PARKINSON DRUGS › DOPAMINERGIC AGENTS › Dopamine agonists
bromocriptine
N04BC01
Forms & Strengths
- Tablet: 2.5 mg
- Capsule: 5 mg
Adult Dosing
- Parkinson's disease: Initial 1.25 mg twice daily with meals, titrate up by 2.5 mg/day every 2-4 weeks; maintenance 10-40 mg/day in 2-3 divided doses
- Hyperprolactinemia-associated dysfunctions: Initial 1.25-2.5 mg daily, titrate by 2.5 mg every 3-7 days as tolerated; usual range 2.5-15 mg/day
- Acromegaly: Initial 1-2.5 mg nightly for 3 days, titrate gradually up to 20-30 mg/day in divided doses
Pediatric Dosing
- Safety and efficacy in pediatric patients under 15 years old have not been established
Indications
- Adjunct in the management of Parkinson's disease (idiopathic or postencephalitic)
- Treatment of amenorrhea, galactorrhea, or female infertility associated with hyperprolactinemia
- Management of growth hormone-secreting pituitary tumors (acromegaly)
Mechanism of Action
- Dopamine D2 receptor agonist in the brain, stimulating postsynaptic dopamine receptors in the corpus striatum
- Inhibits prolactin secretion from the anterior pituitary by acting as a dopamine receptor agonist on lactotroph cells
- Suppresses growth hormone secretion in patients with acromegaly, though paradoxical increases may occur
Contraindications
- Hypersensitivity to bromocriptine or other ergot alkaloids
- Syncopal migraine
- Uncontrolled hypertension
- Pregnancy (when used for Parkinson's disease or hyperprolactinemia-associated conditions without tumor progression)
- Postpartum women with coronary artery disease or history of severe mental disorders
Adverse Reactions
- Nausea, vomiting, constipation, abdominal cramps
- Orthostatic hypotension, dizziness, syncope
- Headache, fatigue, drowsiness
- Psychiatric disturbances (confusion, hallucinations, delusions, depression)
- Raynaud's phenomenon, nasal congestion, pleural/retroperitoneal fibrosis (with chronic high doses)
Drug Interactions
- Dopamine antagonists (e.g., phenothiazines, butyrophenones, metoclopramide) antagonize the therapeutic effects of bromocriptine
- Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin) may increase bromocriptine plasma concentrations and toxicity
- Concomitant use with other ergot alkaloids increases the risk of ergotism, severe hypertension, and vasoconstriction
- Antihypertensive agents may lead to additive hypotensive effects
Curated Content: Needs Vetting Before Put to Clinical Use