Stahl's Essential Psychopharmacology Online
In Collaboration With
Bromocriptine
Therapeutics
Brands
• Parlodel, Serocryptin
Generic?
Yes
Class
• Dopamine agonist, ergot
Commonly Prescribed for
(FDA approved in bold)
• Parkinson's disease (PD)
• Acromegaly
• Hyperprolactinemia
How the drug works
• Dopamine
agonist, with high affinity for the D2 receptor. This action is the
reason for effectiveness. Also has weak alpha-agonist
activity. In the treatment of
hormone-secreting pituitary adenomas, bromocriptine works as a dopamine
agonist, which inhibits
prolactin-secreting cells in the
anterior pituitary, reducing tumor size
How Long Until It Works
• PD - weeks
If It Works
• PD
- may require dose adjustments over time or augmentation with other
agents. Most PD patients will eventually require levodopa-carbidopa
to manage their symptoms
If It Doesn't Work
• PD
- Bradykinesia, gait and tremor should improve. Non-motor symptoms
including autonomic symptoms such as postural hypotension,
depression, and bladder dysfunction
do not improve. If the patient has significantly impaired functioning,
add or replace
with levodopa
Best Augmenting Combos for Partial Response or Treatment-Resistance
• For suboptimal effectiveness add carbidopa-levodopa with or without a COMT inhibitor. MAO-B may also be beneficial
• For younger patients with bothersome tremor: anticholinergics may help
• For severe motor fluctuations and/or dyskinesias with good “on” time, functional neurosurgery (deep brain stimulation) is
an option
• Depression is common in PD and may respond to low dose SSRIs
• Cognitive impairment/dementia is common in mid-late stage PD and may improve with acetylcholinesterase inhibitors
• For
patients with late-stage PD experiencing hallucinations or delusions,
withdraw bromocriptine and consider oral atypical
neuroleptics (quetiapine,
olanzapine, clozapine). Acute psychosis is a medical emergency that may
require hospitalization
for stabilization
Tests
• None required