Bromocriptine
PARLODEL
What it isD2 and D3 dopamine agonist; hyperprolactinemia, Parkinson disease, acromegaly, and type 2 diabetes.
Why this oneIt has 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.
FDA-approved for
- hyperprolactinemia/Parkinson (1978)
Off-label
- neuroleptic malignant syndrome
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperprolactinemia-associated dysfunction | Adults | 1.25–2.5 mg QD | 2.5–15 mg QD | 15 mg QD |
| Prolactin-secreting adenomas | Adults & peds ≥11 yr | 1.25–2.5 mg QD | 2.5–10 mg QD | 10 mg QD |
| Acromegaly | Adults | 1.25–2.5 mg QHS ×3 days | 20–30 mg QHS | 100 mg/day |
| Idiopathic or postencephalitic Parkinsonism | Adults | 1.25 mg BID | individualized | 100 mg/day |
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
- Evaluate for valvular heart disease (echocardiogram) before initiating; do not use if valvular disease present
- Avoid concomitant strong CYP3A4 inhibitors; reduce dose with moderate CYP3A4 inhibitors
- Do not use to inhibit or suppress postpartum physiologic lactation
Contraindications
- History of cardiac valvular disorders or pericardial fibrosis
- History of pleural, pulmonary, or retroperitoneal fibrotic disorders
- Uncontrolled hypertension
- Sensitivity to other ergot alkaloids
Cautions
- Cardiac valvulopathy and pericardial fibrosis (monitor with echocardiogram)
- 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)
NO BOXED WARNINGS
Principal riskNausea and orthostasis; ergot fibrosis at high dose
Cost, est. cash$10–$300/month
Generic entry1998
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.
Mechanism of action: Bromocriptine ballicule
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