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Bromocriptine

Pronunciation

Pronunciation

(broe moe KRIP teen)

Index Terms

  • Bromocriptine Mesylate
  • Cycloset

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Parlodel: 5 mg

Generic: 5 mg

Tablet, Oral:

Cycloset: 0.8 mg

Parlodel: 2.5 mg [DSC] [scored]

Generic: 2.5 mg

Brand Names: U.S.

  • Cycloset
  • Parlodel

Pharmacologic Category

  • Anti-Parkinson Agent, Dopamine Agonist
  • Antidiabetic Agent, Dopamine Agonist
  • Ergot Derivative

Pharmacology

Semisynthetic ergot alkaloid derivative and a sympatholytic dopamine D2 receptor agonist which activates postsynaptic dopamine receptors in the tuberoinfundibular (inhibiting pituitary prolactin secretion) and nigrostriatal pathways (enhancing coordinated motor control).

In the treatment of type 2 diabetes mellitus, the mechanism of action is unknown; however, bromocriptine is believed to affect circadian rhythms which are mediated, in part, by dopaminergic activity, and are believed to play a role in obesity and insulin resistance. It is postulated that bromocriptine (when administered during the morning and released into the systemic circulation in a rapid, 'pulse-like' dose) may reset hypothalamic circadian activities which have been altered by obesity, thereby resulting in the reversal of insulin resistance and decreases in glucose production, without increasing serum insulin concentrations (Gaziano 2010; Pijl 2000).

Distribution

Vd: ~61L

Metabolism

Primarily hepatic via CYP3A; extensive first-pass biotransformation (Cycloset: ~93%)

Excretion

Feces (~82%); urine (2% to 6%)

Time to Peak

Serum: Cycloset: 53 minutes; Parlodel: 2.5 ± 2 hours

Duration of Action

8 to12 hours

Half-Life Elimination

Cycloset: ~6 hours; Parlodel: 4.85 hours

Protein Binding

90% to 96% (primarily albumin)

Special Populations: Hepatic Function Impairment

Plasma levels may increase with hepatic impairment.

Use: Labeled Indications

Acromegaly (excluding Cycloset): Treatment of acromegaly

Hyperprolactinemia (excluding Cycloset): Treatment of prolactin-secreting pituitary adenoma or disorders associated with hyperprolactinemia including amenorrhea with or without galactorrhea, hypogonadism, or infertility

Parkinson disease (excluding Cycloset): Treatment of the signs and symptoms of idiopathic or postencephalitic Parkinson disease; as adjunctive treatment to levodopa (alone or with a peripheral decarboxylase inhibitor)

Type 2 diabetes mellitus (Cycloset only): To improve glycemic control in adults with type 2 diabetes mellitus (noninsulin dependent, NIDDM) as an adjunct to diet and exercise

Use: Unlabeled

Neuroleptic malignant syndrome

Contraindications

Hypersensitivity to bromocriptine, ergot alkaloids, or any component of the formulation

Additional product-specific contraindications:

Cycloset: Syncopal migraine; breast-feeding

Parlodel: Uncontrolled hypertension; pregnancy (risk to benefit evaluation must be performed in women who become pregnant during treatment for acromegaly, prolactinoma, or Parkinson disease - hypertension during treatment should generally result in efforts to withdraw); postpartum women with a history of coronary artery disease or other severe cardiovascular conditions (unless withdrawal of medication is medically contraindicated)

Dosing: Adult

Acromegaly: Oral: Initial: 1.25 to 2.5 mg daily increasing by 1.25 to 2.5 mg daily as necessary every 3 to 7 days; usual dose: 20 to 30 mg daily (maximum: 100 mg/day)

Hyperprolactinemia: Oral: Initial: 1.25 to 2.5 mg daily; may be increased by 2.5 mg daily as tolerated every 2 to 7 days until optimal response (range: 2.5 to 15 mg/day)

Parkinsonism: Oral: 1.25 mg twice daily, increased by 2.5 mg daily in 2- to 4-week intervals as needed (maximum: 100 mg/day)

Type 2 diabetes (Cycloset only): Oral: Initial: 0.8 mg once daily; may increase at weekly intervals in 0.8 mg increments as tolerated; usual dose: 1.6 to 4.8 mg once daily (maximum: 4.8 mg/day)

Cycloset dosing adjustment for concomitant therapy:

Moderate CYP3A4 inhibitor (eg, erythromycin): Maximum: 1.6 mg/day

Strong CYP3A4 inhibitors (eg, azole antimycotics, HIV protease inhibitors): Avoid concomitant use and unsure adequate washout of the strong CYP3A4 inhibitor prior to bromocriptine initiation.

Neuroleptic malignant syndrome (off-label use): Oral: 2.5 mg (orally or via gastric tube) every 8 to 12 hours, increased to a maximum of 45 mg daily, if needed; continue therapy until NMS is controlled, then taper slowly (Gortney 2009; Strawn 2007)

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Hyperprolactinemia: Oral:

Children and Adolescents 11 to 15 years (based on limited information): Initial: 1.25 to 2.5 mg daily. Dosage may be increased as tolerated to achieve a therapeutic response (range: 2.5 to 10 mg/day).

Children ≥16 years: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling. However, adjustment may be necessary due to extensive hepatic metabolism; use with caution.

Administration

Administer with food to decrease GI distress.

Cycloset: Administer within 2 hours of waking in the morning.

Dietary Considerations

Administer with food to decrease GI distress.

Storage

Store below 25°C (77°F). Protect Parlodel from light.

Drug Interactions

Alcohol (Ethyl): May enhance the adverse/toxic effect of Bromocriptine. Bromocriptine may enhance the adverse/toxic effect of Alcohol (Ethyl). Monitor therapy

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Alpha-/Beta-Agonists: Ergot Derivatives may enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Avoid combination

Alpha1-Agonists: Ergot Derivatives may enhance the hypertensive effect of Alpha1-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha1-Agonists. Avoid combination

Alpha-Lipoic Acid: May enhance the hypoglycemic effect of Antidiabetic Agents. Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification

Amisulpride: Anti-Parkinson Agents (Dopamine Agonist) may diminish the therapeutic effect of Amisulpride. Amisulpride may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Avoid combination

Analgesics (Opioid): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy

Androgens: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Exceptions: Danazol. Monitor therapy

Antiemetics (5HT3 Antagonists): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy

Anti-Parkinson Agents (Monoamine Oxidase Inhibitor): May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Monitor for signs and symptoms of serotonin syndrome/serotonin toxicity if selegiline or rasagiline is combined with a serotonin modulator. Use of transdermal selegiline with serotonin modulators is contraindicated. Consider therapy modification

Antipsychotic Agents (First Generation [Typical]): Anti-Parkinson Agents (Dopamine Agonist) may diminish the therapeutic effect of Antipsychotic Agents (First Generation [Typical]). Antipsychotic Agents (First Generation [Typical]) may diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Management: Avoid concomitant therapy if possible and monitor for decreased effects of both agents when these combinations cannot be avoided. Atypical antipsychotics such as clozapine and quetiapine may be less likely to reduce the effects of anti-Parkinson agents. Consider therapy modification

Antipsychotic Agents (Second Generation [Atypical]): May diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Management: Consider using an alternative antipsychotic agent when possible in patients with Parkinson disease. If an atypical antipsychotic is necessary, consider using clozapine or quetiapine, which may convey the lowest interaction risk. Consider therapy modification

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Beta-Blockers: May enhance the vasoconstricting effect of Ergot Derivatives. Consider therapy modification

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

BuPROPion: Anti-Parkinson Agents (Dopamine Agonist) may enhance the adverse/toxic effect of BuPROPion. Monitor therapy

Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Avoid combination

CycloSPORINE (Systemic): Bromocriptine may increase the serum concentration of CycloSPORINE (Systemic). Monitor therapy

CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Bromocriptine. Management: The bromocriptine dose should not exceed 1.6 mg daily with use of a moderate CYP3A4 inhibitor. The Cycloset brand specifically recommends this dose limitation, but other bromocriptine products do not make such specific recommendations. Consider therapy modification

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Bromocriptine. Avoid combination

Dapoxetine: May enhance the adverse/toxic effect of Serotonin Modulators. Avoid combination

Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy

Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates. Avoid combination

Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Hyperglycemia-Associated Agents: May diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

Hypoglycemia-Associated Agents: Antidiabetic Agents may enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy

Idelalisib: May increase the serum concentration of CYP3A4 Substrates. Avoid combination

Ivacaftor: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy

Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy

Linezolid: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Management: Due to a risk of serotonin syndrome/serotonin toxicity, discontinue serotonin modulators 2 weeks prior to the administration of linezolid. If urgent initiation of linezolid is needed, discontinue serotonin modulators immediately and monitor closely. Consider therapy modification

Lorcaserin: May enhance the adverse/toxic effect of Ergot Derivatives. Specifically, use of these drugs together may increase the risk of developing valvular heart disease. Lorcaserin may enhance the serotonergic effect of Ergot Derivatives. This could result in serotonin syndrome. Avoid combination

Luliconazole: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy

MAO Inhibitors: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy

Metaxalone: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy

Methylene Blue: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Avoid combination

Methylphenidate: May enhance the adverse/toxic effect of Anti-Parkinson Agents (Dopamine Agonist). Monitor therapy

Metoclopramide: May diminish the therapeutic effect of Anti-Parkinson Agents (Dopamine Agonist). Monitor therapy

Metoclopramide: Serotonin Modulators may enhance the adverse/toxic effect of Metoclopramide. This may be manifest as symptoms consistent with serotonin syndrome or neuroleptic malignant syndrome. Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Nitroglycerin: Ergot Derivatives may diminish the vasodilatory effect of Nitroglycerin. This is of particular concern in patients being treated for angina. Nitroglycerin may increase the serum concentration of Ergot Derivatives. Avoid combination

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification

Palbociclib: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy

Pegvisomant: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Protease Inhibitors: May increase the serum concentration of Ergot Derivatives. Avoid combination

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Quinolone Antibiotics: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Quinolone Antibiotics may diminish the therapeutic effect of Blood Glucose Lowering Agents. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Monitor therapy

Reboxetine: May enhance the hypertensive effect of Ergot Derivatives. Monitor therapy

Roxithromycin: May increase the serum concentration of Ergot Derivatives. Avoid combination

Salicylates: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy

Serotonin 5-HT1D Receptor Agonists: Ergot Derivatives may enhance the vasoconstricting effect of Serotonin 5-HT1D Receptor Agonists. Serotonin 5-HT1D Receptor Agonists may enhance the vasoconstricting effect of Ergot Derivatives. Avoid combination

Serotonin Modulators: May enhance the adverse/toxic effect of other Serotonin Modulators. The development of serotonin syndrome may occur. Exceptions: Nicergoline; Tedizolid. Monitor therapy

Simeprevir: May increase the serum concentration of CYP3A4 Substrates. Monitor therapy

Somatostatin Analogs: May increase the serum concentration of Bromocriptine. Somatostatin Analogs may also delay bromocriptine absorption and time to maximum plasma concentrations. Monitor therapy

Stiripentol: May increase the serum concentration of CYP3A4 Substrates. Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification

Tedizolid: May enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy

Thiazide and Thiazide-Like Diuretics: May diminish the therapeutic effect of Antidiabetic Agents. Monitor therapy

TiZANidine: CYP1A2 Inhibitors (Weak) may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Consider therapy modification

TraMADol: Serotonin Modulators may enhance the adverse/toxic effect of TraMADol. The risk of seizures may be increased. TraMADol may enhance the serotonergic effect of Serotonin Modulators. This could result in serotonin syndrome. Monitor therapy

Adverse Reactions

Note: Frequency of adverse effects may vary by dose and/or indication.

>10%:

Central nervous system: Dizziness, fatigue, headache

Gastrointestinal: Constipation, nausea

Neuromuscular & skeletal: Weakness

Respiratory: Rhinitis

1% to 10%:

Cardiovascular: Hypotension (including postural/orthostatic), Raynaud's phenomenon, syncope, vasospasm (digital)

Central nervous system: Drowsiness, lightheadedness

Endocrine & metabolic: Hypoglycemia (4%; in combination with sulfonylureas or other antidiabetic agents: 7% to 9%)

Gastrointestinal: Abdominal cramps, anorexia, diarrhea, dyspepsia, gastrointestinal hemorrhage, vomiting, xerostomia

Infection: Increased susceptibility to infection

Ophthalmic: Amblyopia

Respiratory: Flu-like symptoms, nasal congestion, sinusitis

Limited to important or life-threatening: Acquired valvular heart disease, alopecia, bradycardia, cardiac arrhythmia, cerebrovascular accident (postpartum), confusion, constrictive pericarditis, depression, dysphagia, epileptiform seizures, ergot alkaloids toxicity, erythromelalgia, gastrointestinal ulcer, hallucination, hypertension (postpartum), increased cerebrospinal fluid pressure, insomnia, myocardial infarction (postpartum), narcolepsy, paresthesia, pericardial effusion, peripheral edema, pleural effusion, pleurisy, psychomotor agitation, pulmonary fibrosis, retroperitoneal fibrosis, seizure (postpartum), status epilepticus (postpartum), tachycardia, transient blindness, urinary incontinence, urinary retention, vasodepressor syncope, ventricular tachycardia

Warnings/Precautions

Concerns related to adverse effects:

• Cardiac valvular fibrosis: Ergot alkaloids and derivatives have been associated with fibrotic valve thickening (eg, aortic, mitral, tricuspid); usually associated with long-term, chronic use.

• Cardiovascular effects: Hypotension, including orthostatic hypotension and syncope, may occur, particularly upon initiation of therapy and dose escalation. In addition, hypertension, seizures, MI, and stroke have been reported. Severe headache or visual changes may precede events. The onset of reactions may be immediate or delayed (often may occur in the second week of therapy). Discontinue therapy and evaluate promptly if hypertension, severe, progressive, or unremitting headache (with or without visual disturbance), or evidence of CNS toxicity develops.

• CNS depression: May cause CNS depression, which may impair physical or mental abilities, and episodes of sudden sleep onset particularly in patients with Parkinson disease; patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery or driving). Consider dosage reduction or discontinuation of therapy if symptoms occur.

• Hallucinations: Visual or auditory hallucinations may occur when administered alone or concomitantly with levodopa; dose reductions or discontinuation may be necessary. Symptoms may persist for several weeks following discontinuation.

• Impulse control disorders: Dopamine agonists used for Parkinson disease or restless legs syndrome have been associated with compulsive behaviors and/or loss of impulse control, which has manifested as new or increased gambling urges, sexual urges, uncontrolled spending, or other intense urges. Dose reduction or discontinuation of therapy reverses these behaviors in some, but not all cases.

• Melanoma: Risk for melanoma development is increased in Parkinson disease patients; drug causation or factors contributing to risk have not been established. Monitor all patients closely for melanoma and perform periodic skin examinations.

• Pleural/retroperitoneal fibrosis: Cases of pleural and pericardial effusions, as well as pleural, pulmonary, and/or retroperitoneal fibrosis and constrictive pericarditis have been reported with prolonged and high-dose daily use. Discontinue therapy if fibrotic changes are suspected.

Disease-related concerns:

• Acromegaly: Appropriate use: In the treatment of acromegaly, discontinuation is recommended if tumor expansion occurs during therapy. In patients treated with pituitary irradiation, withhold therapy for 4 to 8 weeks on a yearly basis to assess both the clinical effects of radiation on the disease process as well as the effects of bromocriptine. Digital vasospasm (cold sensitive) may occur in some patients with acromegaly; may require dosage reduction.

• Cardiovascular disease: Use with caution in patients with cardiovascular disease (myocardial infarction; residual atrial, nodal, or ventricular arrhythmia).

• Dementia: Use with caution in patients with dementia; high doses may be associated with confusion and mental disturbances.

• Diabetic ketoacidosis (Cycloset): Should not be used in patients with diabetic ketoacidosis (DKA).

• Galactose intolerance/malabsorption (Parlodel): Avoid use in patients with rare hereditary problems of galactose intolerance, severe lactase deficiency or glucose-galactose malabsorption.

• Hepatic impairment: Use with caution in patients with hepatic impairment; dosage adjustment may be necessary due to extensive hepatic metabolism.

• Macroadenomas: Discontinuation of therapy in patients with macroadenomas has been associated with rapid regrowth of tumor and increased prolactin serum levels.

• Peptic ulcer disease: Use with caution in patients with peptic ulcer disease; severe gastrointestinal bleeding has been reported (some fatal).

• Prolactin-secreting adenomas: Cerebrospinal fluid rhinorrhea has been observed in some of these patients.

• Psychosis: Use with caution in patients with psychosis; dopamine agonists may exacerbate the disorder or diminish the effectiveness of drugs used to treat the disorder. Use in patients with severe psychotic disorder is not recommended.

• Type 1 diabetes mellitus (Cycloset): Should not be used in patients with type 1 diabetes mellitus (insulin dependent, IDDM).

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Dosage form specific issues:

• Interchangeability (Cycloset): Due to a difference in the formulation and resulting pharmacokinetics of Cycloset ("quick-release" tablet) compared to other formulations of bromocriptine, interchangeability with any other bromocriptine product is not recommended in the setting of type 2 diabetes mellitus management.

Other warnings/precautions:

• Discontinuation of therapy: Dopaminergic agents have been associated with a syndrome resembling neuroleptic malignant syndrome on abrupt withdrawal or significant dosage reduction after long-term use; gradual dosage reduction is recommended when discontinuing therapy.

• Visual monitoring: Monitoring and careful evaluation of visual changes during the treatment of hyperprolactinemia is recommended to differentiate between tumor shrinkage and traction on the optic chiasm; rapidly progressing visual field loss requires neurosurgical consultation.

Monitoring Parameters

Blood pressure and heart rate (orthostatic vital signs; baseline and periodically thereafter); hepatic, renal, hematopoietic, and cardiovascular function (periodically); visual fields (prolactinoma; periodic); pregnancy test during amenorrheic period; growth hormone (acromegaly; periodic); prolactin levels; HbA1c and serum glucose (type 2 diabetes); GI bleeding (patients with history of peptic ulcer); melanoma skin examinations (regular assessment)

Pregnancy Risk Factor

B

Pregnancy Considerations

Bromocriptine crosses the placenta (Molitch 2015). Data collected from women taking bromocriptine during pregnancy suggest the incidence of birth defects is not increased with use. However, the majority of women discontinued use within 8 weeks of pregnancy.

Women with hyperprolactinemia may be infertile, have amenorrhea and galactorrhea. A mechanical contraceptive should be used during therapy until normal ovulatory menses is established. Contraception can then be discontinued if pregnancy is desired. Bromocriptine should be discontinued if pregnancy is confirmed unless needed for treatment of a rapidly expanding macroadenoma. When used for the treatment of acromegaly or Parkinson disease, consider discontinuing therapy during pregnancy. If treatment is withdrawn, monitor for signs and symptoms of an enlarging prolactin secreting tumor. Regardless of indication, if bromocriptine is needed in a pregnant woman, monitor closely for hypertensive disorders during pregnancy and immediately postpartum.

During treatment with bromocriptine, fertility may occur prior to restoration of menses in infertile women, therefore a pregnancy test is recommended every 4 weeks during the amenorrheic period. Once menses resume, pregnancy tests should be done any time a menstrual period is missed. Women not seeking pregnancy should be advised to use appropriate contraception.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience nausea, vomiting, constipation, fatigue, loss of strength and energy, insomnia, rhinorrhea, diarrhea, or lack of appetite. Have patient report immediately to prescriber signs of severe cerebrovascular disease (change in strength on one side is greater than the other, difficulty speaking or thinking, change in balance, or vision changes); signs of low blood sugar (dizziness, headache, fatigue, feeling weak, shaking, tachycardia, confusion, increased hunger, or sweating); severe dizziness; passing out; vision changes; angina; depression; severe headache; shortness of breath; uncontrollable urges; narcolepsy; back pain; black, tarry, or bloody stools; seizures; vomiting blood; severe abdominal pain; swelling of arms or legs; hallucinations; urinary retention; change in amount of urine passed; or confusion (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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