Tweetbromocriptine
(broe-moe-krip-teen)
Alti-Bromocriptine, Apo-Bromocriptine, Parlodel

Classification
Therapeutic: antiparkinson agents
Pharmacologic: dopamine agonists

Pregnancy Category B



Copyright © 2007 by F.A. Davis Company

Indications
Adjunct to levodopa in the treatment of parkinsonism. Treatment of hyperprolactinemia (amenorrhea/galactorrhea), including associated female infertility. Treatment of acromegaly. Unlabelled Uses: Management of pituitary prolactinomas. Management of neuroleptic malignant syndrome.

Action
Activates dopamine receptors in the CNS. Decreases prolactin secretion. Therapeutic Effects: Relief of rigidity and tremor in parkinsonism. Restoration of fertility in hyperprolactinemia. Decreased growth hormone in acromegaly.

Pharmacokinetics
Absorption: Poorly absorbed (30%) from the GI tract
Distribution: Unknown
Metabolism and Excretion: Completely metabolized by the liver
Half-life: Biphasic—initial phase 4–4.5 hr, terminal phase 45–50 hr

TIME/ACTION PROFILE (suppression of various parameters)

ROUTE ONSET PEAK DURATION
PO† 30–90 min 1–2 hr 8–12 hr
PO‡ 2 hr 8 hr 24 hr
PO§ 1–2 hr 4–8 wk¶ 4–8 hr
†Effect on parkinsonian symptoms
‡Effect on serum prolactin levels
§Effect on growth hormone
¶During chronic therapy


Contraindications/Precautions
Contraindicated in: Hypersensitivity to bromocriptine, ergot alkaloids, or bisulfites (capsules only). Severe cardiovascular disease or peripheral vascular disease. Lactation.
Use Cautiously in: Cardiac disease. Mental disturbances. May restore fertility (additional contraception may be required if pregnancy is undesirable). Severe liver impairment (dose reduction required). Pregnancy and children <15 yr (safety not established).

Adverse Reactions/Side Effects*
*CAPITALS indicate life threatening; underlines indicate most frequent.

CNS: dizziness, confusion, drowsiness, hallucinations, headache, insomnia, nightmares. EENT: burning eyes, nasal stuffiness, visual disturbances. Resp: effusions, pulmonary infiltrates. CV: MI, hypotension. GI: nausea, abdominal pain, anorexia, dry mouth, metallic taste, vomiting. Derm: urticaria. MS: leg cramps. Misc: digital vasospasm (acromegaly only).

Interactions
Drug–Drug: Additive hypotension with antihypertensives. Additive CNS depression with antihistamines, alcohol, opioid analgesics, and sedative/hypnotics. Additive neurologic effects with levodopa. Effective on prolactin levels, may be antagonized by phenothiazines, haloperidol, methyldopa, tricyclic antidepressants, and reserpine.

Route/Dosage
Parkinsonism
PO (Adults): 1.25 mg 1–2 times daily, increased by 2.5 mg/day in 2–4 wk intervals (range is 2.5–100 mg/day in divided doses; up to 40 mg/day have been used). Hyperprolactinemia
PO (Adults): 1.25–2.5 mg/day initially, may be gradually increased q 3–7 days up to 2.5 mg 2–3 times daily. Acromegaly
PO (Adults): 1.25–2.5 mg/day for 3 days, increase by 1.25–2.5 mg q 3–7 days until optimal response is obtained (usual range 10–30 mg/day; up to 100 mg/day). Pituitary Adenomas
PO (Adults): 1.25 mg 2–3 times daily, may be increased over several weeks (range 2.5–20 mg/day). Neuroleptic Malignant Syndrome (Unlabeled)
PO (Adults): 5 mg once daily initially, dose increased as required up to 20 mg/day.

Availability
Tablets: 2.5 mg, 5 mg. Capsules: 5 mg.
NURSING IMPLICATIONS

Assessment
Assess patient for allergy to ergot derivatives Monitor blood pressure before and frequently during drug therapy. Instruct patient to remain supine during and for several hours after 1st dose; severe hypotension may occur. Supervise ambulation and transfer during initial dosing to prevent injury from hypotension.
.
Parkinson’s Disease: Assess symptoms (restlessness or desire to keep moving, rigidity, tremors, pill rolling, masklike face, shuffling gait, muscle spasms, twisting motions, difficulty speaking or swallowing, loss of balance control) before and throughout therapy.
Acromegaly: Physical examination including ring size, heel pad thickness, and soft-tissue volume should be assessed throughout therapy.
Hyperprolactinemia: Sella turcica should be evaluated before therapy and yearly with CT scan or MRI scan.
Neuroleptic Malignant Syndrome: Monitor symptoms (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension, hypotension, pallor, tiredness) for improvement.
Lab Test Considerations: May cause ↑ serum BUN, AST, ALT, CPK, alkaline phosphatase, and uric acid levels; usually transient and clinically insignificant Female infertility:Measure serum prolactin concentrations and anterior pituitary function before therapy. Monitor ovulation during therapy.
Acromegaly: Monitor serum growth hormone and insulin-like growth factor (IGF-I) concentrations periodically during therapy.
Hyperprolactinemia: Measure serum prolactin concentrations monthly during initial therapy and twice yearly during maintenance therapy to determine effectiveness of therapy.
.


Potential Nursing Diagnoses
Impaired physical mobility (Indications).
Risk for injury (Indications, Side Effects).


Implementation
This medication is often given concurrently with levodopa or a levodopa-carbidopa combination in the treatment of Parkinson’s disease.
PO: Administer with food or milk to minimize gastric distress. Tablets may be crushed if patient has difficulty swallowing. Taking at bedtime may decrease nausea.


Patient/Family Teaching
Instruct patient to take medication as directed. Take missed doses within 4 hr of the scheduled dose or omit. Do not double doses May cause drowsiness and dizziness. Caution patients to avoid driving and other activities requiring alertness until response to medication is known.
Caution patient to avoid concurrent use of alcohol during the course of therapy.
Instruct patient to inform health care professional immediately if signs of MI (severe chest pain, fainting, fast heartbeat, increased sweating, continuing or severe nausea and vomiting, nervousness, shortness of breath, weakness) or increasing shortness of breath is noted; pulmonary infiltrates and pleural effusions may occur with long-term therapy.
Advise women to consult with health care professional regarding a nonhormonal method of birth control. Women should contact health care professional promptly if pregnancy is suspected.
Emphasize the importance of regular follow-up examinations to determine effectiveness and monitor side effects.
.
Infertility: Instruct women treated for infertility to obtain daily basal body temperatures to determine when ovulation occurs.
Pituitary Tumors: Instruct patients taking bromocriptine for pituitary tumors to inform health care professional immediately if signs of tumor enlargement (blurred vision, sudden headache, severe nausea, and vomiting) occur.


Evaluation/Desired Outcomes
Decrease in tremor, rigidity, and bradykinesia Improvement in balance and gait in patients with Parkinson’s disease.
.
Decrease in galactorrhea in patients with hyperprolactinemia.
Resumption of normal ovulatory menstrual cycles with restoration of fertility (in patients with amenorrhea and galactorrhea, menses usually resume within 6–8 wk, and galactorrhea subsides within 8–12 wk).
Decreased serum levels of growth hormone in patients with acromegaly.
Decrease in the symptoms of neuroleptic malignant syndrome.

Copyright © 2007 by F.A. Davis Company