Bromocriptine-BC

Generic Name: Bromocriptine mesylate
Product Name: Bromocriptine-BC

Indication

Bromocriptine-BC can be used to treat a number of different disorders:

• It can be used to treat certain menstrual problems or to stop milk production (lactation) in some women or men who have abnormal milk leakage. For example it can be used in women who have still born children to prevent engorgement and pain in the breasts.
• It can also be used to treat patients who produce too much prolactin (hyperprolactinaemia) which may be a cause of infertility. Some tumours of the pituitary gland (a hormone secreting gland at the base of the brain) secrete prolactin and can be treated with Bromocriptine-BC in combination with surgery.
• Bromocriptine-BC is also used to treat some people who have Parkinson’s disease. It works by stimulating certain parts of the brain and nervous system that are involved in this disease. This can relieve symptoms of tremor, shaking, stiffness and slow movements in affected patients.
• Bromocriptine-BC is also used to treat a condition called acromegaly where there is overproduction of growth hormone. This can cause overgrowth of bones and soft tissues and lead to complications such as tendon and nerve impingements. Bromocriptine-BC reduces the level of growth hormone in he blood.

Action

Bromocriptine-BC contains the active component bromocriptine that belongs to a class of drugs called the ergot alkaloids. Bromocriptine is mainly used to treat disorders that result from high levels of the hormone prolactin in the blood. Prolactin is produced by the pituitary gland in the brain. Bromocriptine decreases the production of prolactin from the pituitary by stimulating dopamine receptors. These receptors are principally found in the brain. A high prolactin level is associated with several conditions. Over-production of this hormone can cause abnormal production of breast milk in both men and women (galactorrhoea), as well as suppression of the sexual glands (hypogonadism), which can result in infertility. High prolactin levels are also associated with some breast and menstrual disorders. Reducing prolactin levels with bromocriptine can therefore improve these conditions.

Bromocriptine-BC is also sometimes used to prevent or stop milk production for medical reasons following childbirth, miscarriage or abortion. Prolactin is the hormone that stimulates the production of breast milk, hence decreasing the production of prolactin with bromocriptine stops milk production. Inhibition of prolactin secretion can also cause shrinkage of pituitary tumours in patients with prolactinoma. Bromocriptine’s action on dopamine receptors also decreases the production of growth hormone from the pituitary gland. This is useful for treating conditions where growth hormone is overproduced, such as acromegaly.

Lastly bromocriptine can be used to treat Parkinson’s disease. The neurotransmitter dopamine is known to be reduced or absent in the brains of people with Parkinson’s disease, and this is thought to be the cause of the disease symptoms. Stimulating dopamine receptors with bromocriptine is similar to replacing the dopamine in the brain, and this reduces some of the symptoms of Parkinson’s disease.

Dose advice

Formulation

Bromocriptine-BC comes as two different forms:

1. Yellow-white, round flat tablets containing 2.5 mg of the active ingredient bromocriptine. These come in bottles of 60 tablets.
2. Opaque pink, hard gelatin capsules containing 5mg of the active component bromocriptine. These are available in bottles of 60 capsules.

All doses of Bromocriptine-BC should be taken with food otherwise you may experience uncomfortable symptoms of nausea. The initial doses of medications should be taken near bedtime with a snack. After starting the medication you should be careful changing position from lying to sitting or standing. If you do these movements quickly you may experience dizziness, light-headedness and may faint or fall. This is due to a sudden fall in blood pressure that can occur as your body tries to get used to the medication. You should try to take the medications at the same time each day as this produces the best response and helps you remember!The recommended dose will depend on your specific disorder that needs treatment. You should always follow the advice of your doctor regarding your medications. Changes in dose need to be made gradually over weeks and you should not stop the medication suddenly as this may cause adverse effects. As with any other medication, before you start taking Bromocriptine-BC you should inform your doctor of any other medications you may be taking (including those from the chemist and supermarket) and any medical conditions you may have that could interfere with how Bromocriptine-BC works. In particular you should let your doctor know if you:

• Have diabetes, liver problems, stomach problems such as ulcers or problems with blood circulation.
• Are pregnant or intend on becoming pregnant. Although the majority of women who have been treated with bromocriptine medications during pregnancy had no additional risks of miscarriage or malformations, it is still not recommended.
• Are breastfeeding or intent to breastfeed as Bromocriptine-BC inhibits breast milk production.
• Are lactose intolerant as this medication contains lactose as one of its inactive ingredients.
• Have any allergies

Additional precautions:

• You should not take Bromocriptine-BC if you are allergic to bromocriptine or other ergot alkaloids or any other components of the formulations (such as lactose, maleic acid, gelatin, silica etc). You should carefully read the medication pamphlets to ensure there are no ingredients that you may be allergic.
• Be careful drinking alcohol whilst on this medication and Bromocriptine-BC may lower your tolerance.
• Be careful operating machinery or completing other tasks require 100% alertness as Bromocriptine-BC can cause sleepiness, dizziness or mental changes in some patients. Be sure to experiment with the drug and test its effects on you before attempting any of these dangerous tasks.

Typical Doses

Below are some of the typical doses used for each of the conditions described. However, your doctor may be treating you with Bromocriptine-BC for a different reason to those listed or may be using different doses according to your condition and other history. Thus the following is a guide to common doses but you should always follow the advice of your personal doctor.

• For inhibition of breast milk production, you will normally be started on a single tablet (2.5mg) taken twice daily with your morning and evening meals. You will be started on this medication closely following delivery (assuming you are otherwise well) and be treated for a period of 2 weeks. Occasionally patients can have additional milk production after the medication is stopped so you may need to be treated for another week.
• For lowering of prolactin levels, treatment usually starts with half a tablet (1.25mg) taken two to three times daily. If considered necessary the dose may be increased gradually to a whole tablet two to three times daily. Doses for this indication are quite varied and your doctor will carefully change your dose according to your response, side effects and resolution of symptoms. If you have a polactinoma (prolactin secreting tumour) dose up to 15mg may be needed each day in order to shrink the tumour and reduce prolactin levels. This is divided into 2-4 doses accordingly.
• For acromegaly, the usual starting dose is half a tablet taken at night. This is slowly increased over 1-2 weeks to one tablet four times per day. The ongoing dose then usually falls within the range of 10-30mg daily. The maximum dose is 40mg per day.
• For Parkinson’s disease you will usually be started on half a tablet once or twice daily. This dose is gradually increased each week by half a tablet depending on your response. Your final dose will be between 5-40mg daily given in 3 or 4 divided doses.

Schedule

S4 (prescription required).

Common side effects

Like any other medication, Bromocriptine-BC can cause side-effects. The majority of these are mild, transient are rarely require stopping the treatment. However, if you experience any of the following side-effects that are worrying you, do not hesitate to discuss them with your doctor. Note that the following lists of side-effects are not necessarily exhaustive as new side effects are often discovered and reported as more patients use the drug. In addition, it is impossible to predict who will experience side effects. During the first days of treatment patients commonly experience the following:

• Nausea and vomiting.
• Abdominal pain.
• Dizziness.
• Headache.Fatigue.
• Nasal congestion.
• Postural hypotension- A fall in blood pressure when standing or sitting from a lying position. This can cause sensations of light-headedness or cause fainting.

Other common side effects include:

• Sleepiness
• Constipation.

Uncommon side effects

Patients being treated for Parkinson’s disease may suffer from hallucinations, confusion and behavioral disturbances. Less commonly, they may experience delusions, psychotic episodes and delirium. Bromocriptine-BC may also rarely cause:

• Allergic reactions.
• Pleural effusions and other damage to the lungs (fibrosis).
• Heart problems.
• Gastric bleeding in people with severe acromegaly. Be sure to tell your doctor if you notice any signs of bleeding such as black bowel motions.
• Hypertension, myocardial infarction, seizures, stroke and psychiatric disorders very rarely in patients suppressing milk production post-partum. It is not entirely evident whether these complications are due to the medication itself or factors associated with childbirth.

References

1. Australian Medicines Handbook- 130.6.4 Bromocriptine. AMH Pty Ltd. 2006.
2. BROMOCRIPTINE-BC – Consumer Medicine Information. Biochemie Australia Pty Ltd, 2003.
3. MIMS online- Prescribing Information. Bromocriptine-BC. MIMS Australia Pty Ltd 2003.

For further information talk to your doctor.