Bromocriptine
Bromocriptine is an ergot derivative with potent dopaminergic agonist action (high affinity for the D2 receptor site).
·
Bromocriptine is indicated for
treatment of dysfunctions associated with hyperprolactinaemia, acromegaly to
reduce serum growth hormone, and for idiopathic or postencepha-litic
Parkinson’s disease.
·
It is no longer indicated for the
treatment of suppression of physiological post-partum lactation; the FDA (USA)
is of the opinion that bromocriptine may cause a serious adverse effect in
post-partum women.
The
drug is well absorbed on oral administration and peak plasma levels are reached
in about 2 hours. The plasma half-life of bromocriptine is approximately 6 to 8
hours. The volume of distribution is 1 to 4 L/kg, and plasma protein binding is
to the extent of 96%. Liver is the main site of metabolism and the main route
of excretion is biliary. Less than 0.1% is excreted unchanged.
Bromocriptine
is a synthetic ergoline and a direct dopamine D2
agonist stimulant. Some of its activity includes inhibi-tion of the release of
prolactin by the pituitary, resulting in decreased plasma prolactin
concentrations. Bromocriptine, as a dopamine agonist, occupies dopaminergic
receptors in the pituitary gland to inhibit prolactin secretion. The D2
receptor sites show properties related to dopaminergic behavioural and
endocrine responses.
·
Nausea, vomiting, vertigo, postural
hypotension, nasal congestion, constipation, and mood disturbances.
·
Less common problems include
headache, dryness of mouth, mydriasis, hallucinations, digital vasospasm,
eryth- romelalgia,* and bladder disturbances.
·
Diplopia, dyskinesia, anginal pain,
and ergotism have also been reported.
·
Long-term therapy may result in
pleural effusion, pleural and pulmonary fibrosis, retroperitoneal fibrosis, and
pleu- ritic chest pain.
·
Hypothermia, hypertension,
myocardial infarction, stroke, and seizures have been reported in postpartum
women who were given bromocriptine for lactation suppression.
·
Sudden discontinuation can result in
hyperpyrexia.
·
Bioavailability of bromocriptine is
increased if it is given along with erythromycin.
·
Alcohol reduces tolerance to
bromocriptine and vice versa.
·
Bromocriptine has been reported to
sensitise patients to acute dystonic crisis following administration of a neuro-
leptic. Dopamine antagonists, such as the neuroleptics or leptic. Dopamine
antagonists, such as the neuroleptics or C
·
dopamine agonists when given
concurrently. Life-threatening symptoms of seizures, cerebral vasospasm,
ventricular tachycardia and cardiac dysfunction have been reported when
bromocriptine was combined with sympa- thomimetics.
·
Drowsiness, vertigo, postural
hypotension, sweating, hallucina-tions, agitation, convulsions, nausea, and
vomiting. Dyskinesias may occur.
· Gastric
lavage can be done if the patient is seen within a short time post-ingestion (upto 2 to 3 hours). Activated
charcoal may not be beneficial.
· Rest of the treatment involves
supportive and symptomatic measures. Most cases of overdose with bromocriptine
appear minimal and treatable with supportive care.
· Monitor CNS changes for possible
dyskinesias or seizures. Specific treatment for dyskinesias primarily includes
reduc-tion of dosage and supportive care.
· If the patient is hyperactive,
administer diazepam 10 to 20 mg orally to adults, (no more than 0.1 mg/kg in
children).
· Blood pressure and ECG must be
followed up in sympto-matic patients.
· Because of the significant protein
binding of bromocriptine, haemodialysis is not expected to be of benefit.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.