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Bromocriptine Mesylate

Pronouncation: (BROE-moe-KRIP-teen MEH-sih-LATE)
Class: Antiparkinson agent

Trade Names:
Parlodel
- Tablets 2.5 mg (as mesylate)
- Capsules 5 mg (as mesylate)

Apo-Bromocriptine (Canada)
Parlodel (Canada)
PMS-Bromocriptine (Canada)

Pharmacology

Feedback for Bromocriptine Mesylate

As a treatment for...	Avg User Ratings [?]
Hyperprolactinemia	8.0 1 comments Rate it!
Parkinson's Disease	Be the first to rate it 0 comments
Acromegaly	Be the first to rate it 0 comments

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Stimulates dopamine receptors in the corpus striatum, relieving parkinsonian symptoms. Inhibits prolactin, which is responsible for lactation, and lowers elevated blood levels of growth hormone in acromegaly.

Pharmacokinetics

Absorption

28% of oral dose absorbed.

Distribution

90% to 96% bound to serum albumin.

Metabolism

Completely metabolized.

Elimination

Major elimination route is via the bile; 2.5% to 5% is excreted in urine and 84.6% is excreted in feces in 120 h.

Indications and Usage

Treatment of hyperprolactinemia-associated disorders (eg, amenorrhea with or without galactorrhea, infertility, hypogonadism) in patients with prolactin-secreting adenomas; therapy for female infertility associated with hyperprolactinemia; treatment of acromegaly; therapy for Parkinson disease (idiopathic or postencephalitic).

Unlabeled Uses

Treatment of hyperprolactinemia associated with pituitary adenomas; therapy for neuroleptic malignant syndrome; treatment of cocaine addiction.

Contraindications

Sensitivity to ergot alkaloids; severe ischemic heart disease or peripheral vascular disease; pregnancy.

Dosage and Administration

Hyperprolactinemia-Associated Disorders
Initial dose

PO 1.25 to 2.5 mg/day; 2.5 mg may be added as tolerated every 3 to 7 days until optimum response. (Dosage range, 2.5 to 15ߙmg/day).

Acromegaly
Initial dose

PO 1.25 to 2.5 mg for 3ߙdays at bedtime; may be increased by 1.25 to 2.5 mg as tolerated every 3 to 7ߙdays until optimum response occurs. Dosage range, 20 to 30ߙmg/day, not to exceed 100 mg/day.

Parkinson Disease
Initial dose

PO 1.25 mg twice daily titrated individually. Dosage range, 10 to 40ߙmg/day, not to exceed 100ߙmg/day.

General Advice

Give with milk or meals to reduce gastric distress. Initial dose is usually given at bedtime because of adverse CNS reactions (eg, dizziness, fainting).
Tablet may be crushed if patient has difficulty swallowing.

Storage/Stability

Store at room temperature in tightly-closed container.

Drug Interactions

Dopamine antagonists (eg, phenothiazines, butyrophenones, metoclopramide)

May reduce bromocriptine efficacy.

Erythromycin

May increase bromocriptine serum levels.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Hypotension (including orthostatic); syncope; hypertension; stroke; digital vasospasm.

CNS

Headache; dizziness; fatigue; lightheadedness; fainting; drowsiness; psychosis; seizures; abnormal involuntary movements; hallucinations; confusion; ataxia; insomnia; depression; vertigo; “on-off” phenomenon.

EENT

Visual disturbances, nasal congestion.

GI

Nausea; vomiting; abdominal cramps; constipation; diarrhea; anorexia; indigestion/dyspepsia; GI bleeding.

Respiratory

Shortness of breath; pulmonary infiltrates; pleural effusion; pleural thickening.

Miscellaneous

Exacerbation of Raynaud syndrome; asthenia.

Precautions

Monitor

Assess for exacerbation of Raynaud syndrome (eg, muscle cramps in hands or feet, cold feet).

Pregnancy

Pregnancy category undetermined.

Lactation

Contraindicated in breast-feeding women.

Children

Safety and efficacy in children younger than 15 yr of age not established.

Acromegaly

Cold-sensitive digital vasospasms and severe GI bleeding from peptic ulcers have been reported in patients with acromegaly; institute appropriate treatment. Possible tumor expansion has occurred; monitor patient's condition and discontinue treatment if necessary.

Parkinson disease

Safe use longer than 2 yr has not been established. Periodic evaluation of hepatic, hematopoietic, cardiac, and renal functions is necessary.

Pituitary tumors

Evaluate pituitary before treatment to determine if tumor is present.

Symptomatic hypotension

Do not administer to postpartum patients until BP normalizes. Use caution in patients with pre-eclampsia and in those who have received other drugs that may alter BP.

Patient Information

Tell patient not to skip doses or take double doses.
Caution patient not to discontinue drug suddenly, and to avoid rapid recurrence of original symptoms. Explain that dosage will be tapered slowly before stopping use of drug.
Advise women of childbearing age to use nonhormonal methods of birth control during therapy.
Instruct patient to inform health care provider immediately if pregnancy is suspected.
When used for infertility, instruct patient to obtain daily basal body temperatures to determine when ovulation occurs.
Advise patients who are taking drug to suppress lactation that breast engorgement may occur as therapy is discontinued.
Inform patient that adverse reactions are common, especially during initial phase of therapy.
Instruct patient to notify health care provider if increasing dyspnea or nasal congestion occurs.
Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
Advise patient to avoid intake of alcoholic beverages.
Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.