Bromocriptine Dosing for Neurogenic Fever
The recommended starting dose of bromocriptine for neurogenic fever is 2.5 mg twice daily, with gradual titration up to 5-10 mg twice daily as needed for temperature control. 1
Mechanism and Rationale
Neurogenic fever is a condition characterized by core temperature >37.5°C driven by neurological dysregulation in the absence of infection or significant inflammatory processes. It commonly occurs in patients with:
- Brain injuries
- Thalamic hemorrhage
- Pontine hemorrhage
- Severe traumatic brain injury
Bromocriptine, a dopamine agonist, helps regulate temperature control centers in the hypothalamus that may be disrupted following neurological injury.
Dosing Protocol
- Initial dose: 2.5 mg orally twice daily 1
- Titration: Increase by 2.5 mg every 3-7 days based on temperature response
- Target dose: 5-10 mg twice daily
- Maximum dose: Generally not to exceed 30 mg/day total for this indication
Monitoring Parameters
- Core temperature (esophageal, bladder, or intravascular preferred over skin or tympanic) 2
- Vital signs, particularly blood pressure (watch for orthostatic hypotension)
- Neurological status
- Signs of increased intracranial pressure
- CK levels, renal function, and electrolytes 2
Clinical Pearls
- Temperature normalization typically begins within 24-48 hours of reaching an effective dose
- Fever spikes may recur with attempts to wean bromocriptine, suggesting the need for continued therapy until the underlying neurological condition stabilizes 1
- Maintain euvolemia during treatment to support normal hemodynamic parameters 2
- Avoid fluid restriction, which was previously thought to reduce cerebral edema 2
Alternative Agents
If bromocriptine is ineffective or poorly tolerated, consider:
- Propranolol: Starting at 10-20 mg three times daily, titrated up to 40-80 mg three times daily 3
- Baclofen: Starting at 5 mg three times daily, titrated up to 20 mg three times daily 4
Potential Side Effects of Bromocriptine
- Orthostatic hypotension
- Nausea/vomiting
- Mental status changes
- Dyskinesias
- Hallucinations
Important Considerations
- Distinguish neurogenic fever from neuroleptic malignant syndrome, which features severe muscle rigidity, autonomic instability, markedly elevated CK levels, and recent exposure to dopamine antagonists 2
- Automated feedback-controlled temperature management devices are recommended for precise temperature control during the acute phase 2
- Target core temperature of 36.0-37.5°C irrespective of intracranial pressure 2
- Continue treatment until the underlying neurological condition stabilizes, which may require weeks to months of therapy
The case reports demonstrating successful use of bromocriptine for neurogenic fever show that it can be an effective treatment option when conventional antipyretics fail 1, 5.