bromocriptine mesilate: clinical use

Prescribing considerations

• Establish the cause of hyperprolactinaemia and assess for hypothalamic or pituitary disease.
• Evaluate pituitary function in macroadenoma and replace deficient hormones where necessary.
• Evidence is insufficient for premenstrual symptoms and benign breast disease; use is not recommended.
• For postpartum lactation suppression, restrict use to clear medical indications and assess cardiovascular, psychiatric and hypertensive risk carefully.
• Consider hepatic impairment because reduced elimination may increase exposure.
• Ask patients and carers about somnolence, sudden sleep and impulse-control symptoms.

Contraindications and cautions

• Hypersensitivity to bromocriptine, any excipient or another ergot alkaloid.
• Uncontrolled hypertension, hypertensive disorders of pregnancy, or postpartum or puerperal hypertension.
• For lactation suppression or other non-life-threatening indications: coronary artery disease, other severe cardiovascular disease, or severe psychiatric disorder or history.
• For long-term treatment: cardiac valvulopathy identified by pretreatment echocardiography.
• Rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption because the tablet contains lactose.

Monitoring

• Check blood pressure carefully at treatment initiation, particularly after childbirth.
• Before long-term treatment, assess for cardiac valvulopathy; investigate symptoms or findings suggestive of fibrosis.
• For macroprolactinoma, monitor tumour size, pituitary function and visual fields as clinically appropriate.
• During pregnancy with a prolactinoma, monitor for headache, visual change or other evidence of tumour enlargement.
• Review unexplained sleepiness, sudden sleep episodes, hallucinations and impulse-control behaviours.

Clinical pharmacology

Bromocriptine is an ergot-derived dopamine-receptor agonist that inhibits anterior-pituitary prolactin secretion and can reduce elevated growth hormone. It undergoes extensive hepatic metabolism, principally involving CYP3A4, and is mainly eliminated through the liver.

Formulation and product differences

• The selected product is a white to off-white, uncoated, scored tablet that can be divided into equal halves.
• It contains lactose and is essentially sodium-free.
• Store in the original packaging, protected from light and below the stated storage limit.

Tablet

Route: Oral

Strengths: 2.5 mg