I don’t see bromocriptine used very often in clinical practice, but as a pharmacist, I feel the need to know every medication I come across. Here’s a list of my top bromocriptine clinical pearls!
I think one of the most important things to recognize is that bromocriptine is a dopamine agonist. If you remember this fact, this will help you recognize many important bromocriptine clinical pearls.
One of the first items I wanted to mention is that bromocriptine can be used for the management of hyperprolactinemia. I think one of the most important things to do as a pharmacist is recognize medications that may increase the risk for hyperprolactinemia. Agents with dopamine blocking activity need to be recognized as potential contributors as we don’t want to contribute to the prescribing cascade. Be sure to assess patients to see if they are taking an antipsychotic or metoclopramide. Some antipsychotics are worse than others for this adverse effect. Risperidone tends to be one of the worst while aripiprazole is one of the better ones.
Remembering that bromocriptine is a dopamine agonist should also help you remember the adverse effect profile. Psychiatric changes such as hallucinations are possible with bromocriptine, especially as dosages are increased.
Recall that ropinirole and pramipexole are also dopamine agonists. These drugs have been associated with contributing to impulse control disorders (i.e. gambling, etc.). Bromocriptine also falls within this category and has been associated with these issues.
Bromocriptine (marketed under the brand name Cycloset) also has an indication for diabetes. I can honestly say that I have never seen this agent used for this indication, but I wanted to include it because it is such a unique fact.
As far as drug interactions go, there are two very notable ones that come to mind. Hypotension is a potential adverse effect, so if you have a patient who is taking other drugs that can contribute to this potential effect, we may run into an additive type effect.
Bromocriptine can be affected by CYP3A4 drug interactions. Inhibitors are likely to raise concentrations and increase the risk for adverse effects.
There you have it, my top bromocriptine clinical pearls! Anything else you’d like to add? Leave a comment below!
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