Bromocriptine

Dopamine D2 receptor agonist, ergot derivative

ATC code: N04BC01 (Bromocriptine)

Brand names

Parlodel, Cycloset

Mechanism of action

Activates postsynaptic dopamine D2 receptors in pituitary, striatum and other brain regions. In pituitary suppresses prolactin and growth hormone secretion. In nigrostriatal system compensates for dopamine deficit in Parkinson disease. Ergot structure retains vasoconstrictor activity and serotonin receptor binding, hence vasospasm and valvulopathy risk. Metabolised by CYP3A4.

Indications

Hyperprolactinemia

Second line

Bromocriptine is a second-line dopamine agonist for hyperprolactinemia and pituitary microadenomas. SEEN recommends cabergoline as first choice (better tolerability and twice-weekly dosing); bromocriptine remains an option in pregnancy and when cabergoline is unavailable. Effect over 1–3 months, dose titrated from 1.25 mg twice daily.

Sources

Drug–drug interactions

2 pairs found. Sorted from critical to minor.

Critical

Clarithromycin

Macrolide antibiotic

Mechanism

CYP3A4 inhibition – bromocriptine rises 4-5 fold.

Symptoms

MI, stroke.

Management

Combination contraindicated.

Sources

AEMPS: Ficha tecnica de Parlodel (bromocriptina) (2023)

Pair details →

Critical

Erythromycin

Macrolide antibiotic

Mechanism

Erythromycin inhibits CYP3A4 – bromocriptine rises 4-5 fold. Coronary vasospasm and MI reported.

Symptoms

Nausea, vomiting, MI.

Management

Combination contraindicated. Alternative – azithromycin.

Sources

AEMPS: Ficha tecnica de Parlodel (bromocriptina) (2023)

Pair details →

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Safety

Contraindications

Uncontrolled hypertension
Eclampsia, preeclampsia
Ischemic heart disease
Peripheral vascular disease
Prior psychosis
Combination with erythromycin, clarithromycin (CYP3A4)

Serious adverse effects

Stroke and MI (especially in lactation suppression)
Psychosis, hallucinations
Retroperitoneal and pleuropulmonary fibrosis on long-term use
Impulse control disorders

Common adverse effects

Nausea, vomiting
Orthostatic hypotension
Headache
Nasal congestion
Drowsiness

PregnancyFDA B

Among dopamine agonists, bromocriptine has the most pregnancy data without increased birth defect rate. Used when pregnancy is planned in women with prolactinoma.

Breastfeeding

Suppresses lactation – not used in nursing mothers. Historically used for lactation suppression; FDA withdrew that indication in 1994 due to stroke cases.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Bromocriptine used for?

Bromocriptine is evaluated for the following indications with varying evidence strength: Hyperprolactinemia (evidence tier A). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Bromocriptine?

Common side effects of Bromocriptine (≥ 1 in 100): Nausea, vomiting, Orthostatic hypotension, Headache, Nasal congestion, Drowsiness. See the Safety section for uncommon and serious reactions.

Is Bromocriptine safe during pregnancy?

FDA category B. Among dopamine agonists, bromocriptine has the most pregnancy data without increased birth defect rate. Used when pregnancy is planned in women with prolactinoma.

Is Bromocriptine compatible with breastfeeding?

Suppresses lactation – not used in nursing mothers. Historically used for lactation suppression; FDA withdrew that indication in 1994 due to stroke cases.

Who should not take Bromocriptine?

Bromocriptine is contraindicated in: Uncontrolled hypertension; Eclampsia, preeclampsia; Ischemic heart disease; Peripheral vascular disease; Prior psychosis. Full list in the Safety section.

Mechanism of action

Drug–drug interactions

2 pairs found. Sorted from critical to minor.

Critical

Clarithromycin

Macrolide antibiotic

Mechanism

CYP3A4 inhibition – bromocriptine rises 4-5 fold.

Symptoms

MI, stroke.

Management

Combination contraindicated.

Sources

AEMPS: Ficha tecnica de Parlodel (bromocriptina) (2023)

Pair details →

Critical

Erythromycin

Macrolide antibiotic

Mechanism

Erythromycin inhibits CYP3A4 – bromocriptine rises 4-5 fold. Coronary vasospasm and MI reported.

Symptoms

Nausea, vomiting, MI.

Management

Combination contraindicated. Alternative – azithromycin.

Sources

AEMPS: Ficha tecnica de Parlodel (bromocriptina) (2023)

Pair details →

Safety

Contraindications

Uncontrolled hypertension
Eclampsia, preeclampsia
Ischemic heart disease
Peripheral vascular disease
Prior psychosis
Combination with erythromycin, clarithromycin (CYP3A4)

Serious adverse effects

Stroke and MI (especially in lactation suppression)
Psychosis, hallucinations
Retroperitoneal and pleuropulmonary fibrosis on long-term use
Impulse control disorders

Common adverse effects

Nausea, vomiting
Orthostatic hypotension
Headache
Nasal congestion
Drowsiness

PregnancyFDA B

Among dopamine agonists, bromocriptine has the most pregnancy data without increased birth defect rate. Used when pregnancy is planned in women with prolactinoma.

Breastfeeding

Suppresses lactation – not used in nursing mothers. Historically used for lactation suppression; FDA withdrew that indication in 1994 due to stroke cases.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Bromocriptine used for?

What are the side effects of Bromocriptine?

Common side effects of Bromocriptine (≥ 1 in 100): Nausea, vomiting, Orthostatic hypotension, Headache, Nasal congestion, Drowsiness. See the Safety section for uncommon and serious reactions.

Is Bromocriptine safe during pregnancy?

FDA category B. Among dopamine agonists, bromocriptine has the most pregnancy data without increased birth defect rate. Used when pregnancy is planned in women with prolactinoma.

Is Bromocriptine compatible with breastfeeding?

Suppresses lactation – not used in nursing mothers. Historically used for lactation suppression; FDA withdrew that indication in 1994 due to stroke cases.

Who should not take Bromocriptine?

Bromocriptine is contraindicated in: Uncontrolled hypertension; Eclampsia, preeclampsia; Ischemic heart disease; Peripheral vascular disease; Prior psychosis. Full list in the Safety section.