Bromocriptine Mesylate

The typical dosage of Bromocriptine Mesylate depends on the condition being treated:

For Hyperprolactinemia:

• Starting dose: 1.25 mg to 2.5 mg taken once daily, usually with food to reduce gastrointestinal side effects.
• Maintenance dose: The dose may be gradually increased to 2.5 mg to 15 mg per day, divided into several doses as needed.

For Parkinson’s Disease:

• Starting dose: 1.25 mg to 2.5 mg taken once daily, usually in the evening.
• Maintenance dose: The dose may be gradually increased based on response and tolerance, with a typical range of 10 mg to 40 mg per day, divided into multiple doses.

For Type 2 Diabetes (as Cycloset):

• Starting dose: 0.8 mg taken once daily within two hours of waking in the morning, with food.
• Maintenance dose: The dose may be increased by 0.8 mg per week to a maximum of 4.8 mg per day.

Bromocriptine Mesylate is contraindicated in patients with:

• Uncontrolled hypertension, as the medication can cause a further increase in blood pressure.
• Known hypersensitivity to ergot alkaloids or any component of the formulation.
• Severe cardiovascular conditions, such as coronary artery disease or peripheral vascular disease.
• Pregnancy-induced hypertension (e.g., preeclampsia, eclampsia).

Patients using Bromocriptine Mesylate should be advised to:

• Take the medication exactly as prescribed, and not to skip doses or stop taking the medication abruptly without consulting their healthcare provider.
• Monitor for signs of low blood pressure, particularly when starting the medication or increasing the dose, as Bromocriptine can cause orthostatic hypotension (a drop in blood pressure when standing up).
• Report any unusual symptoms, such as severe headaches, chest pain, or difficulty breathing, to their healthcare provider immediately, as these could be signs of serious side effects.
• Be aware of potential interactions with other medications, especially other dopamine agonists, antihypertensives, or ergot-derived drugs.
• Avoid consuming alcohol while taking Bromocriptine, as it can increase the risk of side effects such as dizziness and low blood pressure.

• Nausea and vomiting
• Dizziness or lightheadedness, especially when standing up (orthostatic hypotension)
• Headache
• Fatigue
• Constipation
• Nasal congestion

• Cardiovascular Events: Such as heart attack, stroke, or worsening of pre-existing heart conditions.
• Psychiatric Effects: Including hallucinations, confusion, or mood changes, particularly in patients with Parkinson’s disease.
• Pulmonary or Retroperitoneal Fibrosis: A rare but serious side effect associated with long-term use of ergot-derived medications.

Patients should seek immediate medical attention if they experience severe or persistent side effects.

• Orthostatic Hypotension: Bromocriptine can cause significant drops in blood pressure when standing up, leading to dizziness or fainting. Patients should rise slowly from sitting or lying down and report any symptoms of hypotension to their healthcare provider.
• Cardiovascular Risks: Bromocriptine can increase the risk of serious cardiovascular events, particularly in patients with pre-existing heart conditions or uncontrolled hypertension. Close monitoring of blood pressure and heart function is recommended.
• Fibrosis: Long-term use of ergot derivatives, including Bromocriptine, has been associated with the development of fibrotic conditions such as pulmonary or retroperitoneal fibrosis. Patients should be monitored for signs of fibrosis, particularly if they experience persistent cough, shortness of breath, or abdominal pain.

Bromocriptine Mesylate may interact with other medications, including:

• Antihypertensive Agents: Concurrent use may increase the risk of hypotension.
• Dopamine Antagonists: Such as antipsychotics, which can reduce the effectiveness of Bromocriptine by blocking dopamine receptors.
• Ergot Alkaloids: Concurrent use of other ergot-derived medications may increase the risk of ergotism (severe vasoconstriction leading to ischemia).
• Macrolide Antibiotics: Such as erythromycin, which can increase the levels of Bromocriptine in the blood by inhibiting its metabolism.

Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.

Alternative treatments for the conditions treated by Bromocriptine include:

• For Hyperprolactinemia: Other dopamine agonists, such as cabergoline, which may be better tolerated or more effective in some patients.
• For Parkinson’s Disease: Other dopamine agonists like pramipexole or ropinirole, as well as levodopa, which is the most commonly used medication for Parkinson’s disease.
• For Type 2 Diabetes: Other oral antidiabetic agents, such as metformin, sulfonylureas, or DPP-4 inhibitors, depending on the patient’s specific needs and response to therapy.

The choice of treatment depends on the specific condition, the patient’s response to previous treatments, and any underlying medical conditions.