Bromocriptine, an ergot derivative, is a dopamine D2-agonist. It inhibits the secretion of prolactin from the anterior pituitary and is used in the treatment of prolactinoma and endocrinological disorders associated with hyperprolactinaemia, including amenorrhoea, galactorrhoea, hypogonadism, and infertility in both men and women. Bromocriptine is also used to suppress puerperal lactation for medical reasons; it is not recommended for the routine suppression of physiological lactation or for the treatment of postpartum breast pain and engorgement that may be adequately relieved with simple analgesics and breast support. Growth hormone secretion may be suppressed by bromocriptine in some patients with acromegaly. Because of its dopaminergic activity bromocriptine is also used in the management of Parkinson’s disease.
Bromodel is usually given by mouth as the mesilate in Kenya; doses are expressed in terms of the base. Bromocriptine mesilate 2.87¬†mg is equivalent to about 2.5¬†mg of bromocriptine. Oral doses should be taken with food. Bromocriptine mesilate has also been given intramuscularly as a depot injection for disorders associated with hyperprolactinaemia.
For the treatment of other conditions (see below) the dose of bromocriptine is usually increased gradually. In the UK, typically, an initial dose of 1 to 1.25¬†mg at night is given, increased to 2 to 2.5¬†mg at night after 2 to 3 days, and subsequently increased by 1¬†mg every 2 to 3 days to a dose of 2.5¬†mg twice daily, or more if necessary. In the USA, a usual starting dose is 1.25 to 2.5¬†mg daily increased by 2.5¬†mg every 2 to 7 days.
In the treatment of hypogonadism and galactorrhoea syndromes and infertility in Kenya bromocriptine is introduced gradually as described above. Most patients with hyperprolactinaemia respond to 7.5¬†mg daily but up to 30¬†mg daily may be required. Infertile patients without raised serum concentrations of prolactin are usually given 2.5¬†mg twice daily. In patients known to have prolactinomas the dose is also introduced gradually as described above and may then be increased further by 2.5¬†mg every 2 to 3 days to a dose of 5¬†mg every 6 hours but occasionally patients may require up to 30¬†mg daily.
In cyclical benign breast and menstrual disorders bromocriptine is introduced gradually up to a usual dosage of 2.5¬†mg twice daily; for the treatment of premenstrual symptoms therapy should begin on day 14 of the cycle.
Bromocriptine may be used as an adjunct to surgery and radiotherapy to reduce plasma-growth hormone concentrations in acromegalic patients. In the UK, it is introduced gradually as described above and may then be increased further by 2.5¬†mg every 2 to 3 days if necessary up to 5¬†mg every 6 hours, according to response. In the USA, the usual starting dose (see above) may be increased by 1.25 to 2.5¬†mg every 3 to 7 days to a maximum daily dose of 100¬†mg if necessary; the usual dosage range is 20 to 30¬†mg daily.
In Parkinson’s disease bromocriptine has been used alone, although it is usually given as an adjunct to levodopa treatment. It should be introduced even more gradually than the regimen above, and during this period patients already receiving levodopa can have their levodopa dosage decreased gradually until an optimal response is achieved. In the UK, a suggested initial dose is the equivalent of 1 to 1.25¬†mg of bromocriptine at night during week 1, increased to 2 to 2.5¬†mg at night for week 2, 2.5¬†mg twice daily for week 3, and for week 4, 2.5¬†mg three times daily; the dose may be increased thereafter by 2.5¬†mg every 3 to 14 days according to response. Most patients require doses within the range of 10 to 40¬†mg daily. In the USA, a usual starting dose is 1.25 to 2.5¬†mg twice daily increased by 2.5¬†mg every 14 to 28 days to a maximum dose of 100¬†mg daily if necessary.