Bromocriptine for

Tennant F., Sagherian A. Double-blind comparison of amantadine and bromocriptine for ambulatory withdrawal from cocaine dependence. Arch. Intern. Med. 147 109, 1987. 

Clarke CE, SpeUer JM. Pergolide versus bromocriptine for levodopa-induced complications in Parkinson s disease. Cochrane Database Syst Rev 1999. 

We would also suggest prophylactic concomitant bromocriptine for several weeks, with gradual tapering after that time period. Such prophylactic approaches during the retreatment phase have been attempted in a few patients, but there are no controlled studies. Nevertheless, it seems like a sensible strategy and poses little additional risk. 

Bromocriptine is a D2 agonist its structure is shown in Table 16-6. This drug has been widely used to treat Parkinson s disease in the past, but is now rarely used for this purpose, having been superseded by the newer dopamine agonists. Bromocriptine is absorbed to a variable extent from the gastrointestinal tract peak plasma levels are reached within 1-2 hours after an oral dose. It is excreted in the bile and feces. The usual daily dose of bromocriptine for parkinsonism varies between 7.5 and 30 mg. To minimize adverse effects, the dose is built up slowly over 2 or 3 months from a starting level of 1.25 mg twice daily after meals the daily dose is then increased by 2.5 mg every 2 weeks, depending on the response or the development of adverse reactions. 

Uribe M., Garcia-Ramos, G., Ramos, M., Valverde, C., Marquez, MA., Farca, A., Guevara, L. Standard and higher doses of bromocriptine for severe chronic portal-systemic encephalopathy. Amer. J. Gastroenterol. 1983 78 517-522... 

Retroperitoneal fibrosis (SEDA-12, 123) (18) and pulmonary fibrosis (SEDA-11, 130) during treatment with high doses of bromocriptine have been observed. The drug s structural relation to methysergide clearly has to be kept in mind. Pleural thickening and effusions can be present in up to 6% of patients treated with bromocriptine for Parkinson s disease, and this is related to duration of exposure and cumulative dose (19). The author recommended drug withdrawal in these patients. However, withdrawal does not always lead to complete resolution of the lesions (20). 

Bromocriptine suppresses lactation and the infant should not be breast-fed from the moment treatment is begun. If bromocriptine is deliberately (and successfully) used to suppress lactation, breast tenderness and milk leakage can ensue. It has been suggested that the use of bromocriptine for this purpose raises the risk of postpartum seizures, but the evidence is equivocal (SEDA-17, 146). 

Dutt S, Wong F, Spurway JH. Fatal myocardial infarction associated with bromocriptine for postpartum lactation suppression. Aust NZ J Obstet Gynaecol 1998 38(1) 116-17. 

Darkening of the sweat has been described (43). Darkening of the white hair of a patient who was taking levodopa in combination with bromocriptine for Parkinson s disease has been reported (SEDA-15,133). 

Handelsman L, Rosenblum A, Palij M, et al. Bromocriptine for cocaine dependence A controlled clinical trial. Am J Addict 1997 6 54-64. 

Cabergoline appears to be more effective than bromocriptine for the medical management of prolactinomas and offers the advantage of less-frequent dosing and decreased adverse events. 

Evidence from a single patient, who was taking bromocriptine for acromegaly, suggests that its effects can be opposed by griseofuivin. 

A 73-year-old man taking levodopa/benserazide and bromocriptine for Parkinson s disease was given lansoprazole 15 mg daily to treat reflux oesophagitis. Two days later, the patient exhibited akinesia (more motor difficulties and slowness in movements) associated with frequent falls. Lansoprazole was discontinued, with disappearance of the symptoms the day after. About 3 months later the patient was prescribed omeprazole 20 mg daily, which caused no aggravation of Parkinson s disease over the following 6 months. 

A 32-year-old woman took two 5-mg doses of bromocriptine for milk suppression without any adverse effects following the birth of a child. Within 2 hours of taking a third dose with phenylpropanolamine 50 mg she awoke with a very severe headache and was found to have a blood pressure of 240/140 mmHg. She was given 5 mg of intramuscular morphine and her blood pressure became normal within 24 hours. Another 5-mg dose of bromocriptine taken 48 hours after the original dose of phenylpropanolamine had the same effect, but the blood pressure rise was less severe (160/120 mmHg). ... 

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