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bromocriptine (Rx)Brand and Other Names:Cycloset, Parlodel

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 5mg

tablet

  • 0.8mg
  • 2.5mg
more...

Hyperprolactinemia (Parlodel)

Initial: 1.25-2.5 mg PO qDay

May increase by 2.5 mg/day q2-7Days

Usual therapeutic dosage 5-7.5 mg/day, ranges from 2.5-15 mg/day

Up to 30 mg/day has been used in some patients with amenorrhea &/or galactorrhea

Parkinson Disease (Parlodel)

1.25 mg PO q12hr

May increase dose by 2.5 mg/day q2-4Weeks

Safety >100 mg/day not established

Acromegaly (Parlodel)

1.25-2.5 mg PO qHS for 3 days

May increase by 1.25-2.5 mg/day at q3-7Days

Not to exceed 100 mg/day

Diabetes (Cycloset)

Quick release formulation (Cycloset) is the only bromocriptine product indicated for diabetes mellitus type 2 as adjunct to diet and exercise to improve glycemic control

Initial dose: 1 tablet (0.8 mg) PO qDay increased weekly by 1 tablet until maximal tolerated daily dose of 1.6-4.8 mg is achieved

Take within 2 hours after waking in the morning with food

Note: Cycloset is not indicated for hyperprolactinemia, Parkinson disease, or acromegaly

Neuroleptic Malignant Syndrome (Off-label)

2.5-5 mg PO 2-3 times/day; not to exceed 45 mg/day

Administration: take with food

Hepatic Impairment

Dose adjustment may be necessary; there are no guidelines

Dosing Considerations

Not for treatment of type 1 diabetes or diabetic ketoacidosis

Limited efficacy data in combination with thiazolidinediones

Efficacy has not been confirmed in combination with insulin

Dosage Forms & Strengths

capsule

  • 5mg

tablet

  • 2.5mg
more...

Hyperprolactinemia (Parlodel)

11-15 years: 1.25-2.5 mg PO qDay (initially)

Maintenance: 2.5-10 mg/day

Take with food

Hyperprolactinemia (Parlodel)

Initial: 1.25-2.5 mg PO qDay  

May increase by 2.5 mg/day q2-7Days

Usual therapeutic dosage 5-7.5 mg/day, ranges from 2.5-15 mg/day

Up to 30 mg/day has been used in some patients with amenorrhea &/or galactorrhea

Parkinson disease (Parlodel)

1.25 mg PO q12hr

May increase dose by 2.5 mg/day q2-4Weeks

Safety >100 mg/day not established

Acromegaly (Parlodel)

1.25-2.5 mg PO qHS for 3 days  

May increase by 1.25-2.5 mg/day at q3-7Days

Not to exceed 100 mg/day

Diabetes (Cycloset)

Quick release formulation (Cycloset) is the only bromocriptine product indicated for diabetes mellitus type 2 as adjunct to diet and exercise to improve glycemic control

Initial dose: 1 tablet (0.8 mg) PO qDay increased weekly by 1 tablet until maximal tolerated daily dose of 1.6-4.8 mg is achieved

Take within 2 hours after waking in the morning with food

Note: Cycloset is not indicated for hyperprolactinemia, Parkinson disease, or acromegaly

Neuroleptic malignant syndrome (Off-label)

2.5-5 mg PO 2-3 times/day; not to exceed 45 mg/day

Administration: take with food

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Interactions

Interaction Checker

bromocriptine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Nausea (49%)

            Hypotension (30%)

            Headache (19%)

            Dizziness (17%)

            1-10%

            Abdominal cramps

            Anorexia

            Constipation

            Dyspepsia

            Dysphagia

            Epigastric pain

            GI hemorrhage

            Vomiting

            Drowsiness

            Fatigue

            Faintness

            Hallucinations Visual

            Insomnia

            Lightheadedness

            Nighmares

            Paranoia

            Psychosis

            Seizure

            Vertigo

            Arrhythmias

            Bradycardia

            Hypertension

            MI

            Mottled skin

            Orthostasis

            Vasospasm

            Palpitations

            Pericardial effusions

            Raynaud's syndrome exacertabtion

            Syncope

            Blepharospasm

            BUN increased

            Burning discomfort of the eye

            Diplopia

            Facial pallor

            Leg cramps

            Nasal congestion

            Rash

            Urticaria

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            Warnings

            Contraindications

            Sensitivity to ergot alkaloids

            Uncontrolled hypertension

            Toxemia

            Nursing

            Cycloset: type I DM, DKA, patients with syncopal migraine

            Cautions

            Monitor blood pressure: risk of orthostatic hypotension

            Concurrency with other hypotensive drugs concomitantly

            Hepatic/renal impairment

            In patients undergoing treatment for macroadenoma-related hyperprolactinemia or who have undergone transsphenoidal surgery, a persistent watery nasal discharge may be sign of CSF rhinorrhea

            May impair ability to drive/operate heavy machinery

            History of MI and a residual atrial, nodal or ventricular arrhythmia, especially with Parkinson disease

            Use for prevention of postpartum lactation no longer recommended

            Postmarketing reports suggest that patients treated with anti-Parkinson medications can experience intense urges to gamble, increased sexual urges, intense urges to spend money uncontrollably, and other intense urges

            Epidemiological studies have shown that patients with Parkinson’s disease have a higher risk (2 to 6-fold higher) of developing melanoma than the general population (unsure if related to the disease or drug therapy)

            Avoid abrupt withdrawal (associated with neuroleptic malignant syndrome-like symptoms); discontinue gradually

            Concomitant use with other receptor agonists not recommended

            Conclusive evidence of macrovascular risk reduction with bromocriptine or other antidiabetic agents not demonstrated

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: should not be used during lactation

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Semisynthetic ergot alkaloid, dopamine receptor agonist, inhibits prolactin secretion, and lowers blood levels of growth hormone in acromegaly

            Quick-release formulation of bromocriptine (Cycloset) is thought to act on circadian neuronal activities within the hypothalamus to reset abnormally elevated hypothalamic drive for increased plasma glucose, triglyceride, and free fatty acid levels in fasting and postprandial states in patients with insulin-resistant

            Pharmacokinetics

            Half-life elimination: 4-4.5 hr (initial phase); 8-20 hr (terminal phase)

            Excretion: 85% feces (via biliary elimination); urine (2.5-5.5%)

            Protein bound: 90-96% (to albumin)

            Peak plasma time: 1-3 hr

            Vd: 61L

            Absorption: 28% from GI tract

            Bioavailability: 28% (parlodel); 65-95% (cycloset)

            Metabolism: Completely in liver, principally by hydrolysis of the amide bond to produce lysergic acid and a peptide fragment

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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