Bromocriptine Uses and Dosages
Bromocriptine is primarily used to treat hyperprolactinemic conditions, prolactinomas, acromegaly, Parkinson's disease, and peripartum cardiomyopathy, with specific dosing regimens tailored to each condition. 1, 2
Hyperprolactinemic Conditions and Prolactinomas
Indications:
- Treatment of hyperprolactinemia regardless of cause 3
- Management of prolactin-secreting pituitary adenomas (prolactinomas) 2
- Restoration of gonadal function and fertility in hyperprolactinemic patients 3
- Reduction of prolactinoma size 3, 4
Dosing:
- Initial dose: 1.25-2.5 mg daily with food 1
- Dose titration: Additional 2.5 mg may be added every 2-7 days until optimal therapeutic response 1
- Therapeutic dosage range: 2.5-15 mg daily in adults 1
- Pediatric dosing (ages 11-15): Initial dose of 1.25-2.5 mg daily, with therapeutic range of 2.5-10 mg daily 1
- For resistant cases, cabergoline is now preferred over bromocriptine due to better efficacy and side effect profile 5, 6
Monitoring:
- Frequent evaluation during dose escalation to determine lowest effective dose 1
- Assess prolactin levels to guide therapy 4
- Consider discontinuation if no significant reduction in prolactin levels occurs 4
Acromegaly
Indications:
- Adjunctive therapy for acromegaly, with or without concomitant hyperprolactinemia 3, 7
- Reduction of circulating growth hormone levels 1
Dosing:
- Initial dose: 1.25-2.5 mg at bedtime with food for 3 days 1
- Dose titration: Additional 1.25-2.5 mg every 3-7 days until optimal therapeutic benefit 1
- Usual optimal therapeutic range: 20-30 mg/day 1
- Maximum dosage: 100 mg/day 1
Monitoring:
- Monthly reevaluation with dosage adjustment based on growth hormone reductions or clinical response 1
- Annual withdrawal from therapy for patients treated with pituitary irradiation to assess disease progression 1
Parkinson's Disease
Indications:
- Adjunctive therapy to levodopa/carbidopa for Parkinson's disease 3, 7
- Can allow reduction in levodopa/carbidopa dosage 3
Dosing:
- Initial dose: 1.25 mg twice daily with meals 1
- Dose titration: Increase every 14-28 days by 2.5 mg/day with meals 1
- Assessment at two-week intervals during titration 1
- Maximum dosage: Safety not demonstrated above 100 mg/day 1
Monitoring:
- If reducing levodopa dosage due to adverse reactions, increase bromocriptine gradually in small increments 1
- Low-dose therapy appears effective with reduced side effects 7
Peripartum Cardiomyopathy (PPCM)
Indications:
- Potential use in women with severe acute heart failure caused by PPCM with LVEF <35% 6
- May be most justified in women with LVEF <25% or cardiogenic shock 6
Dosing:
- Based on limited studies: 2.5 mg twice daily for 2 weeks, followed by 2.5 mg daily for 4 weeks 6
- Should be accompanied by at least prophylactic-dosed anticoagulation due to potential hypercoagulability 6
Evidence and Limitations:
- The European Society of Cardiology endorses "BOARD" protocol (Bromocriptine, Oral HF therapy, Anticoagulation, vasoRelaxing agents, Diuretics) for acute PPCM management 6
- Efficacy and safety remain uncertain, particularly in contemporary heart failure management 6
- Multiple studies suggest improved LVEF recovery with bromocriptine 6
- Consider the downsides of prohibiting breastfeeding 6
Type 2 Diabetes Mellitus
Indications:
- Quick-release formulation (Cycloset) approved in the USA for type 2 diabetes mellitus 8
Dosing:
- Up to 4.8 mg daily (much lower than doses used for Parkinson's disease) 8
- Administered in early morning 8
Efficacy:
- Lowers glycated hemoglobin by 0.6-1.2% (7-13 mmol/mol) as monotherapy or in combination with other antidiabetes medications 8
Side Effects and Precautions
Common Side Effects:
- Gastrointestinal intolerance and postural hypotension 5
- Nausea (particularly with diabetes treatment) 8
- Psychological effects (mood changes, depression, aggression, hypersexuality, impulse control disorder) 5
Monitoring Requirements:
- For higher doses used in prolactinomas, echocardiography monitoring may be required 6
- Long-term treatment has minimal harmful effects on renal, hepatic, cardiac, or hematologic functions 2
Special Populations:
- In pregnancy: Safety has been demonstrated 7
- For women of childbearing potential: Use mechanical contraception until normal ovulatory cycles are restored 1
- In children: Limited data in ages 11-15 years 1
Treatment Duration and Discontinuation
- For hyperprolactinemia: Treatment may need to be continued for years as hyperprolactinemia usually recurs upon discontinuation 4
- For acromegaly with pituitary irradiation: Annual withdrawal to assess disease progression 1
- For prolactinomas: Withdrawal after 2+ years may be considered if prolactin levels normalize and no visible tumor remains 6