Makindo Medical Notes

💊 Bromocriptine is used less frequently today as longer-acting dopamine agonists (e.g., cabergoline) are available. ⚠️ Key safety concern: risk of cardiac valvulopathy and serosal fibrosis (pleural, pericardial, retroperitoneal). 📋 Regular monitoring: ESR, U&E, and CXR are advised.

📖 About

Always check the BNF link here for up-to-date information.

• Ergot-derived, short-acting dopamine agonist.
• Historically important in neurology and endocrinology; now largely replaced by safer agents.

⚡ Mechanism of Action

• Dopamine D2 receptor agonist: Acts in the hypothalamus and pituitary to suppress prolactin secretion.
• Prolactin inhibition: Dopamine is the natural prolactin-inhibiting factor → useful in hyperprolactinaemia, infertility, galactorrhoea.
• Motor benefit: In Parkinson’s, dopamine agonism helps restore striatal dopaminergic activity.

💊 Indications & Dosing (Adults)

• Suppression/Prevention of Lactation: 2.5 mg twice daily for 14 days (⚠️ no longer routine in UK due to risk of hypertension/stroke).
• Hyperprolactinaemia / Galactorrhoea: Start 1.25 mg daily → titrate slowly to 2.5–15 mg/day.
• Acromegaly: 1.25 mg/day initially → gradual titration up to 30 mg/day.
• Parkinson’s disease (adjunct): Start 1.25 mg/day → titrate to 2.5–30 mg/day depending on response/tolerance.

🔄 Interactions

• 🚫 Macrolide antibiotics (e.g., clarithromycin, erythromycin): ↑ bromocriptine levels → toxicity risk.
• 💊 Other ergot derivatives: ↑ risk of vasospasm & fibrosis.
• ❗ May antagonise antihypertensives → monitor BP closely.

⚠️ Cautions

• Drowsiness & sudden sleep onset: Warn patients about driving & machinery.
• Raynaud’s phenomenon: May worsen digital vasospasm.
• Impulse control disorders: Monitor for pathological gambling, hypersexuality, compulsive shopping/eating.
• Acute porphyria: Risk of exacerbation.

🚫 Contraindications

• ❌ Preeclampsia, postpartum hypertension, or severe uncontrolled hypertension: Risk of stroke and cardiac events.
• ❌ Hypersensitivity to ergot alkaloids.
• ❌ History of fibrotic disorders (pleural, retroperitoneal, pericardial).

💥 Side Effects

• 🤢 Gastrointestinal: Nausea, vomiting, constipation, diarrhoea.
• 🧠 Neurological: Headache, dizziness, fatigue, confusion, hallucinations.
• ❤️ Cardiovascular: Postural hypotension, digital vasospasm, rare hypertensive crises.
• 🫁 Fibrotic reactions: Pulmonary, retroperitoneal, or cardiac fibrosis (requires ongoing surveillance).
• 🧑‍⚕️ Neuroleptic malignant syndrome-like reaction: Reported on abrupt withdrawal.
• 🧩 Behavioural: Impulse control disorders (gambling, compulsive behaviours, hypersexuality).

📌 Clinical Pearls

• Use cabergoline first-line for hyperprolactinaemia — better efficacy & safety.
• For women needing fertility treatment (prolactinoma-related infertility), bromocriptine is still sometimes used.
• Always monitor ESR, U&E, CXR for fibrosis if used long-term.
• Reassure that lactation suppression is no longer routinely indicated in the UK due to risks — only used if strong indication.