Bromocriptine Antipsychotics

Antipsychotics, bromocriptine, carbamazepine, chlorpropamide, cyclophosphamide, desmopressin, ecstasy, lamotrigine, monamine oxidase inhibitors, NSAIDs, oxcarbazepine, oxytocin, tricyclic antidepressants, selective serotonin reuptake inhibitors, vasopressin, vinblastine, and vincristine... 

Dopamine agonists may also lessen some of the effects of antipsychotics for a case of reduced efficacy see Antipsychotics + Bromocriptine , p.710. 

The answer is b. (Hardman, pp 282—283J Central dopamine receptors are divided into Dt and D2 receptors. Antipsychotic activity is better correlated to blockade of D2 receptors. Haloperidol, a potent antipsychotic, selectively antagonizes at Dz receptors. Phenothiazine derivatives, such as chlorpromazine, fluphenazine, and promethazine, are not selective for D2 receptors. Bromocriptine, a selective D2 agonist, is useful in the treatment of parkinsonism and hyperprolactinemia. It produces fewer adverse reactions than do nonselective dopamine receptor agonists... 

The efficacy of antipsychotics, with respect to dopamine receptors, results mostly from blockade of D -like receptors. Binding of the classical antipsychotics (e.g., bromocriptine and raclopride), however, is about two orders of magnitude stronger at D receptors compared with D receptors. The atypical antipsychotics,... 

A host of medications have been nsed to treat TD including medications that block norepinephrine activity (clonidine and propranolol), dopamine-activating medications (bromocriptine), benzodiazepines, acetylcholine-activating medications, calcium channel blockers, and monoamine oxidase inhibitors. In addition, vitamin E supplementation and atypical antipsychotics including clozapine have been used to treat TD. 

Chlorpromazine is an aliphatic phenothiazine antipsychotic used in schizophrenia and which may exacerbate parkinsonism. Co-careldopa is a combination of levodopa and the peripheral dopa-decarboxylase inhibitor, carbidopa. Co-careldopa, amantadine, entacapone and bromocriptine are all indicated in the management of parkinsonism. 

Bromocriptine (Parl el) [Antiparkinsonian Agent/Dopamine Receptor Agonist] Uses Parkin on Dz, hyperprolactinemia, acromegaly, pituitary tumors Action Direct-acting on the striatal dopamine receptors X prolactin secretion Dose Initial, 1.25 mg PO bid titrate to effect, w/ food Caution [B, ] Contra Severe ischemic heart Dz or PVD Disp Tabs, caps SE X BP, Raynaud phenomenon (vasospastic disorder resulting in discoloration of the fmgers/toes), dizziness, N, hallucinations Interactions T Effects W/ erythromycin, fluvoxamine, nefazodone, sympathomimetics, antihypertensives X effects W/ phenothiazines, antipsychotics EMS Monitor BP may cause intolerance to EtOH OD May cause NA, severe hypotension give IV fluids symptomatic and supportive... 

Immediate discontinuation of the antipsychotic and the use of bromocriptine when needed to manage symptoms if a neuroleptic malignant syndrome develops... 

Atypical drugs, particularly at high doses, can yet cause extrapyramidal effects and this strategy is not always helpful. If the classical antipsychotic is simply continued, tardive dyskinesia reiiiits spontaneously in aroimd 30% of patients within a year but since the condition is difficult to tolerate, patients may be keen to try other medications, even where evidence suggests that the success rates for remission are limited. These include vitamin E, benzodiazepines, 3-blockers, bromocriptine and... 

All basic and advanced life-support measures should be implemented. Gastric decontamination should be performed. Butyrophenones are readily absorbed by activated charcoal. Aggressive supportive care should be instituted. Dystonic reactions respond well to intravenous benztropine or diphenhydramine. Oral therapy with diphenhydramine or benztropine should be continued for 2 days to prevent recurrence of the dystonic reaction. For patients suffering from neuroleptic malignant syndrome, a potentially fatal condition associated with the administration of antipsychotic drugs, dantrolene sodium, and bromocriptine have been used in conjunction with cooling and other supportive measures. Arrhythmias should be treated with lidocaine or phenytoin. Diazepam is the drug of choice for seizures phenytoin is used to prevent recurrence. Hemodialysis and hemoperfu-sion have not been shown to be effective. 

Amphetamines (release Cocaine (prevent re-uptake of DA) Euphoria, hypervigilance, Anxiety, stereotyped behavior, grandiosity, paranoia, tachycardia, pupillary dilation Depression, fatigue, f fkX- CwiSrbictioi Noradrenaline system, NAC pathway (dopaminergic) 1 Antipsychotics or benzodiazepines bromocriptine, amantadine, desipramine Increased use among white professionals, cardiac arrhythmias... 

A. Treatment of NMS caused by neuroleptic dmgs (eg, haloperidol and other antipsychotics) or levodopa withdrawal. Note If the patient has significant hyperthermia (eg, rectal or core temperature >40°C), bromocriptine should be considered secondary and adjunctive therapy to immediate measures such as neuromuscular paralysis and aggressive external cooling. 

Some antipsychotics have dopamine antagonist actions, which wouid be expected to inhibit the efficacy of dopamine agonists such as bromocriptine. Carefui monitoring is required if combined use is considered necessary. 

The concurrent use of bromocriptine with antipsychotics can be successful. However, one report describes the re-emei ence of schizophrenic symptoms in a patient when bromocriptine was added to treatment with molindone and imipramine. Another case reports a rise in prolactin levels and deterioration of vision when thioridazine was given with bromocriptine. 

Single 2-mg doses of bromocriptine have been found to improve the psychopathology of chronic schizophrenia in patients taking antipsychotics and a case report describes a reduction in psychopathology when bromocriptine 2.5 mg daily was given with haloperidol. ... 

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