Bromocriptine
PARLODEL
Pronunciation: broe-moe-KRIP-teen
“Bromance Parlor”
What it isD2 and D3 dopamine agonist; hyperprolactinemia, Parkinson disease, acromegaly, and type 2 diabetes.
Why this oneHas the longest pregnancy experience among dopamine agonists, favoring it when fertility is the goal.
What limits itNausea and orthostasis limit titration; high exposure to this ergot can cause valvular or pulmonary fibrosis.
Pearls
- No longer recommended for Parkinson disease; non-ergot agonists preferred.
Bromocriptine prescription history
Animated chart of estimated U.S. prescriptions per year, Parkinson medicines (1948–2026). Bromocriptine enters in 1978 (estimated).
FDA-approved for
- hyperprolactinemia/Parkinson (1978)
Off-label
- neuroleptic malignant syndrome
Principal riskNausea and orthostasis; ergot fibrosis at high dose
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperprolactinemia-associated dysfunctions (incl. prolactin-secreting adenomas) | Adults | ½–1 × 2½ mg tablet QD | Add 2½ mg as tolerated; clinical range 2.5–15 mg/day | Undefined (2.5–15 mg/day is observed range, not a max) |
| Prolactin-secreting pituitary adenomas | Peds 11–15 yr (limited data) | ½–1 × 2½ mg tablet QD | Increase as tolerated; observed range 2.5–10 mg/day | Undefined |
| Acromegaly | Adults | ½–1 × 2½ mg tablet on retiring (with food) ×3 days | Usual optimal 20–30 mg/day | 100 mg/day |
| Idiopathic or postencephalitic Parkinsonism | Adults | ½ × 2½ mg tablet BID with meals | Individualized | Undefined (safety >100 mg/day not demonstrated) |
Titration Hyperprolactinemia: increase every 2–7 days; acromegaly: every 3–7 days; Parkinsonism: every 14–28 days
Renal Undefined
Hepatic Undefined
Instructions
- Take orally with food
- Caution with strong CYP3A4 inhibitors (azole antimycotics, HIV protease inhibitors); macrolides (erythromycin) raise levels
- Do not use to inhibit or suppress postpartum physiologic lactation
Available strengths
- cap 5 mg
- tab 0.8, 2.5 mg
Contraindications
- Uncontrolled hypertension
- Sensitivity to other ergot alkaloids
Cautions
- Pleural/pericardial effusions, constrictive pericarditis; cardiac valve fibrosis reported (long-term, high-dose)
- Pleural, pulmonary, and retroperitoneal fibrosis (long-term, high-dose)
- Hypotension/orthostatic hypotension, especially early
- Avoid for postpartum lactation suppression (HTN, stroke, MI, seizures, death)
- Impulse control disorders and compulsive behaviors
- Somnolence/sudden sleep onset during daily activities
- Visual field loss in macroprolactinoma; exacerbation of psychosis
Adverse reactions
- Nausea, headache, dizziness, fatigue, lightheadedness, vomiting (hyperprolactinemia)
- Nausea, constipation, orthostatic hypotension (acromegaly)
- Nausea, dyskinesia, hallucinations, confusion (Parkinsonism)
Pregnancy Generally withdraw when pregnancy diagnosed; no evidence of increased birth defects in ~1,276 exposed pregnancies
Lactation Avoid during lactation in postpartum females (inhibits lactation)
Cost
| Strength | #/mo | generic $/mo | brand $/mo | CostPlus | |
|---|---|---|---|---|---|
| 0.8 mg | tab | 30 qd | — | $157.69 | not offered |
| 2.5 mg | tab | 30 qd | $48.28 | — | offered |
| 5 mg | cap | 30 qd | $123.50 | — | out of stock |
Generic entry1998
Open Bromocriptine in the interactive console ↗
Memory aids: interaction avatars
Open Bromocriptine in the interactive console ↗
Self-check
- Why favor bromocriptine when fertility is the goal?
Longest pregnancy experience among dopamine agonists. - What fibrosis can high bromocriptine exposure cause?
Valvular or pulmonary fibrosis.