From the Guidelines
Bromocriptine should not be considered as a first-line treatment for central fever due to the lack of strong evidence supporting its efficacy in improving morbidity, mortality, and quality of life in patients with central fever. Central fever occurs due to damage to temperature-regulating centers in the hypothalamus, often following traumatic brain injury, stroke, or other neurological insults. The current evidence does not support the use of bromocriptine as a standard treatment for central fever, and its use should be approached with caution 1.
Key Considerations
- Before considering any treatment for central fever, it is essential to rule out infectious causes of fever through appropriate workup.
- Treatment should begin after other standard cooling measures have been attempted.
- The medication may take 24-48 hours to show effect, and treatment duration typically continues until fever resolves or stabilizes, often ranging from days to weeks depending on the underlying cause.
- Bromocriptine should be used cautiously in patients with cardiovascular disease, and dose adjustments may be necessary for those with renal or hepatic impairment.
Evidence Review
The most recent and highest quality study on temperature management in acute ischemic stroke was published in 2015 by the European Stroke Organisation 1. This study found that the currently available data about temperature management in acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. Based on the existing data, the study did not make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia.
Clinical Implications
In clinical practice, the treatment of central fever should focus on addressing the underlying cause of the fever, rather than solely relying on pharmacological interventions. The use of bromocriptine for central fever should be individualized and based on a thorough assessment of the patient's condition, taking into account the potential benefits and risks of treatment. Further research is needed to establish the efficacy and safety of bromocriptine in the treatment of central fever 1.
From the Research
Bromocriptine for Central Fever
- Bromocriptine has been used to treat central hyperthermia, which is common in patients with brain injury and can lead to worse outcomes 2, 3, 4, 5, 6.
- The use of bromocriptine in central fever is based on its central dopamine receptor agonism, which is hypothesized to have an antipyretic effect in this setting 4.
- Studies have shown that bromocriptine can be beneficial in managing central hyperthermia, with significant reductions in temperature observed in patients treated with this medication 2, 4, 5.
- The dosing regimens for bromocriptine in central fever vary, with median doses ranging from 7.5 mg to 40 mg per day 4, 5.
- Adverse events associated with bromocriptine use in central fever are generally mild, with hepatotoxicity being the most common reason for discontinuation 5.
- The effectiveness of bromocriptine in central fever has been observed in various patient populations, including those with traumatic brain injury, brainstem hemorrhage, and other acute neurological insults 2, 3, 4, 5, 6.
Efficacy of Bromocriptine
- A retrospective cohort study found that bromocriptine use was associated with a significant decline in temperature, with a nadir at 72 hours post-initiation 4.
- A case report described a patient with intractable central hyperthermia who responded to bromocriptine treatment, with reduction in fever spikes and minor fluctuations in temperature 2.
- Another study found that bromocriptine was associated with a paired mean difference of -0.37°C (p = 0.005) between temperatures before and after initiation 5.
Limitations and Future Directions
- The current evidence for bromocriptine in central fever is largely based on case reports and retrospective studies, highlighting the need for prospective randomized controlled trials to elucidate the risk-benefit profile of this treatment 3, 6.
- Further research is needed to determine the optimal dosing regimens, duration of treatment, and patient selection criteria for bromocriptine in central fever 3, 4, 5.