Bromocriptine and Other Dopaminergic Drugs

Examples

Bromocriptine
Cabergoline

Indications

Prolactinoma
Acromegaly
Suppression / Prevention of lactation

These drugs are licensed for use in suppressing lactation, however they are not recommended for post-partum women as hypertension, seizures, myocardial infarction and stroke have been seen.

Also used in Parkinson's disease, see Dopamine Agonists.

Contraindications

Contraindication

Hypersensitivity to ergot derivatives
Cardiac valvulopathy
Pre-eclampsia
Hypertension in post-partum women

Caution

History of peptic ulcer disease (GI bleeding can occur)
Raynaud's syndrome (vasospasm can occur)
Cardiovascular disease
History of serious mental illness (psychosis can occur)
Acute porphyria
Pregnancy and Breastfeeding

Mechanism

These drugs are dopamine agonists. In the context of prolactinoma, dopamine inhibits prolactin secretion. There is also an effect on growth hormone secretion, which may be beneficial.

Administration

Given orally.

Adverse Reactions

Common

Headache
Nasal Congestion
GI upset
Hallucinations (cabergoline)

Rare but serious:

Fibrotic reactions (pulmonary, pericardial or retroperitoneal) and valvular disease are seen with these drugs. Cardiac valve problems should be excluded prior to treatment, and further tests of baseline lung and renal function may be wise.
Daytime sleepiness and sudden onset of sleep can be a problem with these drugs and patients should be warned about driving / using heavy machinery. If this occurs, they should not drive.
Hypotensive reactions in the initial treatment period can be problematic.
Peptic ulcer and GI bleeding
Arrhythmias
Psychosis

Interactions

Bromocriptine can increase the risk of hypotension when given with other anti-hypertensives such as Bendroflumethiazide, B-blockers and ACE-inhibitors.

Education

Patients should be warned to watch out for side effects and will need regular monitoring. This includes impulse-control disorders which are strongly associated with dopamine agonists.

Pharmacokinetics

Nil of note.

Alimentary

Cardiovascular

CNS (Neurology and Psychiatry)

Malignant Disease and Immunosuppression

Respiratory

Ophthalmology

Endocrine

Infection

Anaesthesia

Reproduction

Musculoskeletal

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Formulary

Bromocriptine and Other Dopaminergic Drugs