💊 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.
