From the Guidelines
Bromocriptine is not recommended as a first-line treatment for neurogenic fever, and instead, controlled normothermia targeting 36.0–37.5 °C is recommended. The provided evidence does not support the use of bromocriptine for treating neurogenic fever, and instead, emphasizes the importance of controlled normothermia in managing temperature in patients with traumatic brain injury 1. Neurogenic fever, defined as core temperature > 37.5 °C driven by neurological dysregulation in the absence of sepsis or a clinically significant inflammatory process, is common in intensive care and is associated with an increased risk of complications and unfavorable outcomes 1.
Some key points to consider when managing neurogenic fever include:
- Correctly differentiating central fever against fever of infectious origin is crucial due to the impact of failing to identify a treatable condition, the negative consequences of antibiotic overuse, and the detrimental effect of hyperthermia on brain-injured patients 1.
- Physiological processes such as brain metabolic rate of oxygen, CO2 control, brain tissue oxygenation, and ICP are directly related to temperature, and the deleterious effects and likelihood of secondary injury may occur irrespective of whether temperature is raised due to infection or impaired thermoregulation 1.
- Controlled normothermia should be considered when pyrexia is secondary to sepsis or inflammatory processes, and when the patient is perceived to be at risk of secondary brain injury, especially in the acute phase of TBI 1.
In terms of treatment, controlled normothermia targeting 36.0–37.5 °C is recommended, and uncontrolled fever (neurogenic or secondary to inflammation or infection) can precipitate secondary brain injury in patients with severe TBI 1. While bromocriptine may have been considered in the past, the current evidence does not support its use as a first-line treatment for neurogenic fever.
From the Research
Efficacy of Bromocriptine for Neurogenic Fever
- Bromocriptine has been shown to be effective in treating neurogenic fever, also known as central fever, in patients with brain injury 2, 3, 4, 5.
- A case report published in 2017 found that bromocriptine was able to control central hyperthermia in a patient with a right thalamic hemorrhage extending to the midbrain and into the ventricles 2.
- A retrospective study published in 2024 found that bromocriptine was associated with a significant reduction in body temperature in patients with central hyperthermia after brain insult, with a paired mean difference of -0.37°C (p = 0.005) between temperatures before and after bromocriptine initiation 3.
- A review of evidence published in 2023 found that bromocriptine, propranolol, and baclofen may be effective in the pharmacologic management of central fever, although significant heterogeneity exists regarding dosing strategies and duration of treatment 4.
- An exploratory analysis published in 2023 found that bromocriptine use was associated with a modest but statistically significant decline in temperature, with a nadir at 72 hours post initiation 5.
Comparison with Other Treatments
- While bromocriptine has been shown to be effective in treating neurogenic fever, other treatments such as baclofen and propranolol may also be effective 4, 6.
- A case report published in 2023 found that the use of oral baclofen and propranolol was a promising therapeutic option for managing neurogenic fever in patients with pontine hemorrhage 6.