Bromocriptine-CV

Bromocriptine is a drug that belongs to the class of ergoline derivatives. This drug acts as a dopamine receptor agonist, mimicking the action of dopamine in the brain. Bromocriptine is widely used to treat various medical conditions related to the endocrine system and the nervous system.

Bromocriptine stimulates dopamine receptors in the brain, which results in a decrease in the production of prolactin by the pituitary gland. This makes it effective in the treatment of conditions associated with excess prolactin secretion.

Indications Bromocriptine

1. Hyperprolactinemia: Bromocriptine is often used to treat hyperprolactinemia, which is characterized by excess levels of prolactin in the blood. This condition can be associated with menstrual irregularities, infertility, hypogonadism, gynecomastia, and other symptoms.
2. Prolactinoma: Bromocriptine may be used to treat prolactinoma, a tumor of the pituitary gland that causes excess prolactin production.
3. Parkinson's disease: Bromocriptine is sometimes used to treat Parkinson's disease as an adjunct or alternative drug to other medications.
4. Empty splenic fossa syndrome: This is a rare condition in which fluid or tissue fills the space below the pituitary gland. Bromocriptine may be used to treat the symptoms associated with this.
5. Suppression of lactation: After delivery, if the woman does not plan to breastfeed, bromocriptine can be used to suppress lactation.

Release form

Bromocriptine is usually available as tablets to take by mouth. The tablets may have different dosages depending on the patient's medical needs and the doctor's prescription.

Pharmacodynamics

1. Dopamine Agonist: Bromocriptine is an agonist of dopamine receptors, particularly dopamine D2 receptors. This results in stimulation of dopaminergic pathways in the brain.
2. Decreased secretion of prolactin: Bromocriptine helps to reduce the secretion of prolactin, a hormone that is responsible for regulating many physiological processes, such as reproductive function, mammary gland and others.
3. Treatment of hyperprolactinemia: Bromocriptine is used to treat hyperprolactinemia, which is when the level of prolactin in the blood is too high. This can lead to menstrual irregularities, galactorrhea, infertility, and other problems.
4. Improving the symptoms of Parkinson's disease: Bromocriptine is also used in the treatment of Parkinson's disease, as its dopaminergic action can help reduce the symptoms of this neurological disease, such as tremors, stiffness, and dyskinesias.
5. Prolactinoma regulation: In the case of prolactinoma, a pituitary tumor that produces prolactin, bromocriptine can be used to shrink the tumor and reduce prolactin secretion.
6. Other endocrine and neurological effects: Bromocriptine may also affect other endocrine systems and neurological functions in the body, which may be useful in the treatment of other diseases and conditions.

Pharmacokinetics

1. Absorption: Bromocriptine is generally well absorbed from the gastrointestinal tract after oral administration.
2. Distribution: It has a wide distribution throughout the body tissues, including the pituitary gland and hypothalamus.
3. Metabolism: Bromocriptine is metabolized in the liver.
4. Excretion: Bromocriptine is excreted primarily through bile and also in urine as metabolites.
5. Elimination half-life: The elimination half-life of bromocriptine is approximately 15 hours.

Dosing and administration

1. Hyperprolactinemia:

   • The starting dosage is usually 1.25 to 2.5 mg taken once or twice daily.
   • The dosage may be gradually increased under the supervision of a physician depending on the response to treatment.
   • The maximum recommended daily dose is usually 15 mg.

2. Parkinson's disease:

   • The initial dosage may be 1.25 to 2.5 mg taken once or twice daily.
   • The dosage may be increased gradually to a maintenance dose under the supervision of a physician.
   • The usual maintenance dose for most patients is 10 to 40 mg per day, given in divided doses.

3. Amenorrhea and anovulatory cycle:

   • Dosage may vary depending on the patient's response to treatment and the goal of treatment.
   • The usual starting dose is 1.25 to 2.5 mg taken once or twice daily.
   • The dosage may be increased or decreased under the supervision of a physician.

Use Bromocriptine during pregnancy

1. Prolactinoma:

   • Bromocriptine is often prescribed to reduce the size of prolactinomas, which are pituitary tumors that produce prolactin. In pregnant women with prolactinomas, bromocriptine may be used to prevent their growth, which may be stimulated by high estrogen levels during pregnancy.
   • However, some studies and clinical data show that prolactinomas often do not increase in size after conception, allowing some women to discontinue bromocriptine treatment during pregnancy.

2. Risks and safety:

   • Although bromocriptine is widely used during pregnancy in women with prolactinomas, it is important to note that its safety for the fetus is not guaranteed. Animal studies have shown some risks, but human data are limited.

3. Doctors' recommendations:

   • If women become pregnant while taking bromocriptine, they are often advised to stop taking the drug unless there are strong indications for continuing it, such as large or rapidly growing tumors.
   • Doctors may regularly monitor prolactin levels and the size of the prolactinoma during pregnancy to assess the need to restart bromocriptine treatment.

Contraindications

1. Individual intolerance or allergic reaction: People with a known individual intolerance to bromocriptine or any other component of the drug should avoid using it.
2. Cardiovascular disease: The use of bromocriptine may be contraindicated in patients with serious cardiovascular disease such as unstable angina, acute myocardial infarction, or heart failure.
3. Hypotension (low blood pressure): Bromocriptine should be used with caution in patients with low blood pressure or a tendency to hypotension, as it may cause a decrease in blood pressure.
4. Vascular disorders: Bromocriptine may be contraindicated in the presence of vascular disorders such as ischemic stroke or severe vascular disease due to the potential for increased vascular effects of the drug.
5. Pregnancy and breastfeeding: The use of bromocriptine during pregnancy and breastfeeding should be agreed with a doctor, since the safety of its use during this period may be limited.
6. Impaired liver function: Patients with impaired liver function may require a dosage adjustment of bromocriptine or its complete discontinuation.
7. Impaired renal function: If renal function is impaired, the dosage of bromocriptine may need to be adjusted or it may need to be discontinued.
8. Weakened thyroid function: Bromocriptine may affect thyroid function, so its use may be contraindicated in cases of thyroid dysfunction.

Side effects Bromocriptine

1. Drowsiness and dizziness: These are some of the most common side effects of bromocriptine. They can affect your ability to concentrate and drive.
2. Psychiatric disorders: Psychiatric side effects such as anxiety, depression, aggression, hallucinations and drowsiness may occur.
3. Headache: Some patients may experience headaches or worsening of existing headaches.
4. Nausea and vomiting: These stomach upsets may occur in some patients while taking bromocriptine.
5. Hypotension: Bromocriptine may cause low blood pressure, which may lead to dizziness or fainting.
6. Heart rhythm disturbances: Some patients may experience heart rhythm disturbances such as tachycardia or arrhythmia.
7. Skin reactions: Allergic skin reactions such as itching, redness, rash or hives may occur.
8. Digestive dysfunction: Diarrhea, constipation or other gastrointestinal disturbances may occur.
9. Vision problems: Some patients may experience vision problems, such as blurred vision or changes in color perception.
10. Other side effects: Include decreased libido, increased milk secretion, dehydration, etc.

Overdose

1. Hypotension: One of the most common symptoms of overdose is a sudden drop in blood pressure, which can lead to dizziness, weakness, fainting, or even loss of consciousness.
2. Tachycardia: Overdose may cause increased heart rate and cardiac arrhythmias.
3. Hyperprolactinemia: Since bromocriptine is used to lower prolactin levels, taking too much in overdose can cause hyperprolactinemia, which can lead to adverse effects associated with this hormone.
4. Neurological symptoms: Neurological symptoms such as headache, dizziness, drowsiness, agitation, seizures, disorientation, or hallucinations may also occur.
5. Liver toxicity: Overdose may result in elevated liver enzyme levels and hepatotoxicity.
6. Other systemic effects: Various other systemic complications are possible, including gastrointestinal disorders, allergic reactions, sleep disturbances, and others.

Interactions with other drugs

1. Dopaminergic drugs: Bromocriptine may enhance the dopaminergic effects of other drugs such as levodopa, dopamine and dopamine agonists, which may lead to an increased risk of side effects.
2. Antihypertensive drugs: Bromocriptine may enhance the hypotensive effect of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors (ACE inhibitors) and beta-blockers.
3. Antiepileptic drugs: Interaction of bromocriptine with some antiepileptic drugs, such as carbamazepine and valproic acid, is possible due to their effect on hepatic metabolism.
4. Drugs that increase hepatic metabolism: Drugs that may increase hepatic metabolism, such as rifampin or phenytoin, may decrease the concentration of bromocriptine in the body.
5. Drugs that decrease hepatic metabolism: Drugs that may decrease hepatic metabolism, such as cytochrome P450 inhibitors (eg, ketoconazole), may increase bromocriptine concentrations and increase the risk of its side effects.