Hallucination bromocriptine

L-DOPA can be initiated at 50 mg taken at bedtime and increased stepwise over a few weeks until the symptoms are relieved. Bromocriptine can be initiated at 7.5 mg at bedtime, pramipexole is often dosed at 0.125-0.375 mg at night, and ropinirole, which has an indication for RLS, is typically administered at 0.25-3 mg at bedtime. These medications are not without side effects. They may cause nausea and, over time, insomnia. Less commonly, these medications can cause hallucinations or involuntary movements called dyskinesias. These side effects usually resolve rapidly upon discontinuing the medication. 

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... 

Other D-2 agonists ergot derivatives inhibit the D-1 receptor these include bromocriptine, lysuride, and CU32-085- The commoner adverse reactions induced by DA agonists comprise nausea, hypotension, dyskinesia, hallucinations and delusions. 

Up to 10% of patients have to be withdrawn from treatment because of psychiatric symptoms. Bromocriptine-induced psychosis is well known and particular caution is warranted in patients with a family history of mental disorders (109). Even very low doses of bromocriptine can cause psychotic reactions (SEDA-9, 126) (SEDA-10, 117), and well-recognized problems include confusion, hallucinations, delusions, and paranoia. 

Bromocriptine is the prototype but causes marked dyskinesias and CNS dysfunctions, including hallucinations, confusion, and psychosis. Formerly used as adjunct or alternative to lev-odopa, bromocriptine has been largely replaced by the non-ergots pramipexole and ropinirole, which are less toxic. However, they may cause sedation, including abrupt sleep onset. 

Toxicity Gastrointestinal effects include anorexia, nausea, and vomiting. Cardiovascular effects commonly include postural hypotension cardiac arrhythmias may also occur. Dyskinesias may occur with abnormal movements similar to those caused by levodopa. Behavioral effects include confusion, hallucinations, and delusions these occur more commonly with bromocriptine and pergolide than with levodopa. Like levodopa, bromocriptine and pergolide are contraindieated in patients with a history of psychosis. Miscellaneous ei ot-related effects with bromocriptine inelude pulmonary infiltrates and erythromelalgia. 

The use of dopaminergic agents in combination with antimuscarinic drugs is common in the treatment of parkinsonism. Bromocriptine does not complicate treatment with antimuscarinic drugs or amantadine. If combined with levodopa, bromocriptine should be used in reduced doses to avoid intolerable adverse effects. Confusion, delusions, and hallucinations occur more frequently with bromocriptine than with levodopa. Bromocriptine does not require bioactivation for its antiparkinson effects. The answer is (C). 

Bromocriptine (Parlodel) Powerful P2 agonist. Parkinson s disease, particularly when tolerance develops to l-dopa or when symptom relief "swings" between doses. Also hyperprolactinemia, adjunct in treatment of pituitary tumors. More nausea, hallucinations, confusion, and hypotension than l-dopa. Less dyskinesia. Nonspecific CNS arousal. 

Pergolide (Permax) D1 and D2 agonist. More potent than bromocriptine. Adjunct to levodopa/carbidopa in Parkinson s Disease patients. Dyskinesia, nausea, rhinitis, constipation, dizziness, hallucinations, somnolence... 

B. Bromocriptine intoxication may present with hallucinations, paranoid behavior, hypertension, and tachycardia. Involuntary movements, hallucinations, and hypotension are reported with pergolide. 

Josamycin. An elderly man with Parkinson s disease, well-controlled for 10 months with daily levodopa/benserazide, bromocriptine 70 mg and domperidone, was additionally given josamycin 2 g daily for a respiratory infection. Shortly after the first dose he became drowsy with visual hallucinations, and began to show involuntary movements of his limbs, similar... 

Side effects similar to those previously reported (SED VIII, p. 322) have been seen in further studies. I en substituting bromocriptine 20—75 mg daily for levodopa in the treatment of parkinsonism 19 patients improved but 7 could not tolerate the change. There were 3 cases of syncope, 2 of hallucinations and one each of emesis, somnolence or slowing of the pulse rate with faintness (26 -). Volunteers given bromocriptine appear to be most sensitive with the first doses when they tend to develop nausea, vomiting or postural hypotension. Patients with raised levels of serum prolactin and acromegaly are less likely to have early side effects and women immediately post-partum are most resistant (27 ). 

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