Adult: 2.5 mg on the day of delivery followed by 2.5 mg bid for 14 days.
Oral Parkinson's disease
Adult: As adjunct to levodopa: 1st wk: Initially, 1-1.25 mg at night; 2nd wk: 2-2.5 mg at night; 3rd wk: 2.5 mg bid; 4th wk: 2.5 mg tid, then increased by 2.5 mg every 3-14 days as required. Maintenance: 10-30 mg daily.
Oral Hypogonadism, Galactorrhoea, Infertility
Adult: Initially, 1-1.25 mg at night, increased to 2-2.5 mg at night after 2-3 days, and subsequently increased by 1-2.5 mg every 2-3 days up to 2.5 mg bid or more if necessary. Max: 30 mg daily.
Oral Prolactinoma (prolactin secreting adenoma)
Adult: Initially,1-1.25 mg at night, increased gradually to 2-2.5 mg daily at 2-3 days interval, then 2.5 mg 8 hrly, 2.5 mg 6 hrly and 5 mg 6 hrly. Max: 30 mg daily. Child: 7-17 yr Initially, 1 mg bid or tid, may gradually increase according to response. Max: 7-12 yr 5 mg daily; ≥13 yr 20 mg daily.
Oral Acromegaly
Adult: Initially, 1-1.25 mg at night, increased gradually to 2-2.5 mg daily at 2-3 days interval then 2.5 mg 8 hrly, 2.5 mg 6 hrly and 5 mg 6 hrly. Child: 7-17 yr Initially, 1.25 mg bid or tid, may gradually increase according to response. Max: 7-12 yr 10 mg daily; ≥13 yr 20 mg daily.
Oral Suppression of lactation
Adult: 2.5 mg daily for 2-3 days, increased to 2.5 mg bid for 14 days.
Administration
Should be taken with food.
Contraindications
Uncontrolled HTN, hypertensive disorders of pregnancy (including eclampsia, pre-eclampsia or pregnancy-induced HTN), HTN post-partum and in the puerperium. Coronary artery disease, other severe CV disorders, symptoms or history of severe psychiatric disorders when used for the suppression of lactation or other non-life-threatening indications. Evidence of cardiac valvulopathy (long-term therapy). Lactation.
Special Precautions
Patient w/ parkinsonian syndrome who manifest mild degrees of dementia or w/ history of MI and a residual atrial, nodal or ventricular arrhythmia, pleuropulmonary signs and symptoms, history of psychosis, CV disease, Raynaud’s syndrome, history of peptic ulcer. Renal or hepatic impairment. Childn. Pregnancy.
Adverse Reactions
Nausea, vomiting, drowsiness, orthostatic hypotension, Raynaud’s syndrome, erythromelalgia, arrhythmias, exacerbation of angina, headache, nasal congestion, dry mouth, constipation, diarrhoea, altered LFTs, dyskinaesia, GI bleeding, psychosis, hallucinations, delusions, confusion, pericarditis, pleural thickening and effusions, sudden sleep onset, hypersexuality, visual disturbance, tinnitus, hair loss. Very rarely, HTN, MI, seizures or stroke.
This drug may cause somnolence and/or sudden sleep onset, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor for pituitary enlargement, visual field to detect secondary field loss in macroprolactinoma fibrotic disease; BP and heart rate (at baseline and periodically), GI bleeding and pregnancy test during amenorrheic period.
Overdosage
Symptoms: Vomiting, nausea, dizziness, hypotension, postural hypotension, tachycardia, drowsiness, somnolence, lethargy, confusion and hallucination. Management: Symptomatic and supportive treatment. Administer activated charcoal; may perform gastric lavage if intake is very recent. May give metoclopramide for emesis or hallucinations.
Drug Interactions
Increased plasma level w/ erythromycin and other macrolide antibiotics. Effects of antihypertensives may be potentiated. Diminished therapeutic effect w/ dopamine antagonists such as psychotropics (e.g. phenothiazines, butyrophenones, thioxanthenes). Additive neurologic effect w/ levodopa. Reduced prolactin-lowering effect w/ metoclopramide and domperidone. Potentially severe adverse effects may occur w/ concomitant use of other ergot alkaloids.
Food Interaction
Food reduces nausea caused by bromocriptine. Alcohol reduces tolerance to bromocriptine.
Action
Description: Mechanism of Action: Bromocriptine is a dopamine D2 agonist which activates postsynaptic dopamine receptors in the tuberoinfundibular pathway that inhibits the secretion of prolactin from the anterior pituitary and may lower blood level of growth hormone. It also stimulates nigrostriatal pathways in the corpus striatum to enhance coordinated motor control. Pharmacokinetics: Absorption: Rapidly absorbed from the GI tract. Bioavailability: Approx 6%. Time to peak plasma concentration: W/in 1-3 hr. Distribution: Plama protein-binding: 90-96%, mainly albumin. Metabolism: Undergoes extensive hepatic first-pass metabolism; converted to lysergic acid and peptides via hydrolysis. Excretion: Via faeces (approx 82%) and urine (approx 2-6%). Elimination half-life: Biphasic: Approx 4-4.5 hr; 15 hr.
Chemical Structure
Bromocriptine Source: National Center for Biotechnology Information. PubChem Database. Bromocriptine, CID=31101, https://pubchem.ncbi.nlm.nih.gov/compound/Bromocriptine (accessed on Jan. 21, 2020)
G02CB01 - bromocriptine ; Belongs to the class of prolactine inhibitors. Used to suppress lactation. N04BC01 - bromocriptine ; Belongs to the class of dopamine agonist. Used in the management of Parkinson's disease.
References
Anon. Bromocriptine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 28/06/2016.Bromocriptine Tablet (Paddock Laboratories, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 28/06/2016.Buckingham R (ed). Bromocriptine Mesilate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 28/06/2016.Joint Formulary Committee. Bromocriptine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 28/06/2016.McEvoy GK, Snow EK, Miller J et al (eds). Bromocriptine Mesylate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 28/06/2016.
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