Nausea bromocriptine

Parkinsonian patients receiving the dopamine precursor, levodopa or dopamine receptor agonists, such as bromocriptine and apomoiphine may experience nausea and vomiting due to stimulation of dopamine D2 receptors in the CTZ. 

Bromocriptine directly binds to the D2 receptors on the lac-totroph cells to exert its effect. Bromocriptine normalizes prolactin level, restores menstrual cycles, and reduces tumor size in approximately 90% of patients.49 Adverse effects such as nausea, dizziness, and orthostatic hypotension often limit 5% to 10% of patients from continuing treatment. Thus, start bromocriptine at a low dose (e.g., 0.625-1.25 mg) at bedtime... 

Bromocriptine (Parlodel ) 0.625-1.25 mg/day at bedtime 1.25 mg increments at 1 -week interval 2.5-1 5 mg/day 40 mg/day 2 to 3 divided doses per day Dizziness, headache, syncope, nausea, vomiting, Gl cramps, orthostatic hypotension ... 

Amenorrhea related to Bromocriptine 2.5 mg by mouth 2-3 Elypotension, nausea,... 

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 Inhibits adenylyl cyclase and interacts with other intracellular pathways Restores dopamine actions in the central nervous system Parkinson s disease, prolactinemia Oral Toxicity Nausea, headache, orthostatic hypotension... 

Bromocriptine is generally taken after the evening meal at the initial dose of 1.25 mg the dose is then increased as tolerated. Most patients require 2.5-7.5 mg daily acromegalics require higher doses, up to 20 mg/d. Bromocriptine tablets may be administered intravaginally to reduce nausea. Long-acting oral bromocriptine formulations (Parlodel SRO) and intramuscular formulations... 

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. 

BROMOCRIPTINE, CABERGOUNE ERYTHROMYCIN t bromocriptine and cabergoline levels Inhibition of metabolism Monitor BP closely and watch for early features of toxicity (nausea, headache, drowsiness)... 

ALCOHOL BROMOCRIPTINE t risk of severe side-effects if alcohol is taken at the same time. (e.g. nausea, stomach pain, dizziness) Uncertain Be aware... 

The most common adverse effects of bromocriptine therapy include central nervous system symptoms such as headache, lightheadedness, dizziness, nervousness, and fatigue. Gastrointestinal effects such as nausea, abdominal pain, or diarrhea also are very common. Some patients may need to take bromocriptine with food to decrease the incidence of adverse gastrointestinal effects. Most adverse effects are seen early in the course of therapy and tend to decrease with continued treatment. Bromocriptine may cause thickening of bronchial secretions and nasal congestion. There have been rare cases of psychiatric disturbances, pleural diseases, and an erythromeMgic syndrome... 

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. 

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... 

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 ). 

Of 14 patients taking bromocriptine 5 mg daily for benign prostatic enlargement 4 had to stop treatment 3 developed nausea, lethargy, headache and unsteadiness and one had a hypotensive episode after the first dose (30 =). 

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