A B O U T   Y O U R   M E D I C I N E

BROMOCRIPTINE in ACROMEGALY

This medicine is also supplied under the trade name Parlodelâ and is available as:
Tablets containing Bromocriptine 1 mg and 2.5 mg.
Capsules containing Bromocriptine 5 mg and 10 mg are also occasionally used.

How does it work?

Bromocriptine acts on the pituitary gland to block the production and release of growth hormone which is produced in excessive amounts in acromegaly. Although growth hormone levels are unlikely to be reduced to near normal by Bromocriptine, they still fall sufficiently to bring about an improvement in the metabolic and other complications of this condition. Improvement is usually noticed after about two months of treatment and is maintained on treatment thereafter.

Treatment is usually started at low dosage then increased gradually until the required regular (maintenance) dose has been reached. This reduces the likelihood of early side effects. The maintenance dose varies from patient to patient and depends on what is required to control your symptoms. Dosages up to 20 mg daily may be required.

This medicine should be taken with food to coincide with the main meals of the day. See under Side effects (below)

Nausea
Nausea (but not necessarily vomiting) is a common problem at the outset so that it is advisable to slowly increase your dose of Bromocriptine until the required maintenance dose has been reached. Usually you will be prescribed tablets of 2.5 mg strength with the aim of gradually building up the strength at a pace which the patient finds tolerable. The following detailed schedule is provided for your guidance.

• Go to bed with a glass of milk and a sandwich.
• After drinking half the milk and eating some of the sandwich, take half a 2.5 mg tablet of Bromocriptine, then finish the milk and sandwich.
• Do this for three nights.
• On the fourth night take a whole tablet of Bromocriptine, again "sanwiched" between food.
• Do this for another three nights, then stop the bed-time routine of milk, sandwich and Bromocriptine.
• Instead, take the whole tablet in the middle of your evening meal.
• After three days you should attempt to increase the dosage by taking an additional half tablet in the middle of your breakfast while continuing to take a tablet during your evening meal.
• After a further three days, increase the dose to one whole tablet with breakfast and, of course, with your evening meal.
• After another three days, take half a tablet with your lunch then three days later increase this to a whole tablet at lunchtime.
• You should now be taking your tablets three times a day in the middle of breakfast, lunch and the evening meal.
• Further dosage increases can be managed by the above strategy.

If you do develop troublesome nausea at any time this can be overcome by lowering the dosage to that which you previously tolerated. You should then wait for four days before gradually increasing the dose once more.

Sudden falls in blood pressure may occur in the first few days of treatment causing dizziness especially when changing from the lying to the sitting or the sitting to the standing position. You should therefore sit up or stand up carefully to prevent dizzy turns and the risk of falling until you have become "used" to your medicine. This problem is unlikely to persist but may be more troublesome if you also take alcohol.

Headaches, abdominal discomfort, nasal congestion, constipation (and even diarrhoea) are occasionally reported by patients who take Bromocriptine.

Other side effects are uncommon at the dose used for the treatment of acromegaly. High doses of Bromocriptine taken for months or years have, however, been associated with disturbances of mood and behaviour and treatment may not be appropriate for patients who suffer from mood or behavioural disorders.

If side effects persist or you feel unable to cope - contact your doctor. Do not stop taking your medicine. It may be possible for your doctor to overcome any problems by prescribing treatment at a lower dosage.

Alcohol – the fact that side effects can be more troublesome if alcohol is also taken with your medicine has already been mentioned above.

Cough/cold remedies – some constituents of these medicines (which are bought at the Chemist) may cause the blood pressure to rise too sharply and should be avoided. The constituents in question are: ephedrine, phenylephrine, phenylpropanolamine, pseudoephedrine and xylometazoline. If in doubt – check with your Pharmacist before purchasing cough or cold remedies.

Bromocriptine tablets and capsules should be stored at room temperature. Keep in the original container in which they have been dispensed and protect from direct sunlight.

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.