Bromocriptine

Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.

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The active ingredient bromocriptine is a so-called dopamine agonist: It mimics the effect of the body's own messenger substance dopamine. Therefore, bromocriptine is suitable for the treatment of Parkinson's disease and various dysfunctions of the pituitary gland. Here you can read all the important effects and use of bromocriptine, side effects and interactions.

This is how bromocriptine works

Nerve cells in the human brain communicate with each other via messenger substances (neurotransmitters). Such neurotransmitters can be released by one cell and perceived by the next via certain docking points (receptors) on its surface. In this way a certain signal can be passed on. One of these messenger substances is dopamine, also known as the "happiness hormone". It takes care of many processes such as influencing the psyche (feeling of motivation, increased drive), perception, movement control of the body and also the milk production in mothers.

The active ingredient bromocriptine mimics the effects of dopamine in certain areas of the brain when there is a lack of dopamine. Such a deficiency occurs in Parkinson's disease because dopamine-producing nerve cells in the midbrain increasingly die off. These cells emit their messenger substance via long processes into certain regions of the cerebrum, the putamen, part of the basal ganglia. The basal ganglia are the areas of the brain that control the body's movements. Due to the lack of dopamine, Parkinson's patients experience rigidity and rigidity, generally reduced movements and trembling of the hands. As a dopamine agonist, bromocriptine can relieve these symptoms.

In addition, the dopamine mimicked bromocriptine causes nerve cells in the pituitary gland (pituitary gland) to stop releasing prolactin. This hormone stimulates milk production in mothers, for example. It also inhibits the release of growth hormones, which, for example, can be increased in tumors of the pituitary gland.

Uptake, breakdown and excretion of bromocriptine

After ingestion as a tablet, bromocriptine is absorbed quickly, but only halfway through the intestine. A large part of it is broken down in the liver before it reaches the great bloodstream (what is known as the “first pass” effect). As a result, only a little under five percent of the active ingredient reaches the brain via the bloodstream. Bromocriptine is broken down in the body by the liver and excreted in the stool. One and a half days after ingestion, the bromocriptine level in the body has halved again.

When is bromocriptine used?

The active ingredient bromocriptine is approved alone or together with the active ingredient L-DOPA for the treatment of Parkinson's disease.

It is also used after childbirth to suppress milk production, for example if the woman has had a stillbirth or is infected with HIV. The active ingredient can also be used if the milk production is accompanied by very great pain.

Bromocriptine is also approved as an adjunct treatment for acromegaly. The overproduction of growth hormone leads to excessive growth of the chin, nose, larynx and other organs. Acromegaly is usually a tumor of the pituitary gland.

The treatment is either short-term over two weeks for weaning or permanent for the treatment of chronic diseases such as Parkinson's.

This is how bromocriptine is used

The active ingredient bromocriptine is taken in the form of tablets or capsules. The dosage depends on the type and severity of the disease. The treatment is usually started gradually, i.e. with a low dose, which is then slowly increased to a maximum of 30 milligrams of bromocriptine daily. The total daily amount is divided evenly over the day into three to four individual doses, which are taken with a glass of water with or immediately after a meal.

What are the side effects of bromocriptine?

Possible bromocriptine side effects in more than one in ten patients are headache, dizziness, fainting, fatigue, depressive mood and symptoms of the gastrointestinal tract (nausea, constipation, diarrhea, gas, cramps and pain).

Often, confusion, restlessness, delusions, sleep disorders, anxiety, movement disorders, visual disturbances, nasal congestion, dry mouth, hair loss, muscle cramps, discomfort when urinating and allergic reactions (swelling, redness and pain) develop. If allergic symptoms occur, a doctor should be notified.

What should be considered when taking bromocriptine?

The combination of bromocriptine and other active substances can lead to interactions:

Bromocriptine is broken down in the liver by certain enzymes (cytochrome P450 3A4), which also break down many other drugs. Their breakdown can be inhibited if taken at the same time, so that the active ingredient concerned accumulates in the body and can increasingly lead to serious or even toxic side effects. This is possible, for example, with antifungal agents (itraconazole, ketoconazole), HIV drugs and antibiotics (erythromycin, griseofulvin).

Alcohol should only be drunk with caution during therapy, as it is less well tolerated.

No motor vehicles or heavy machinery should be operated because of the risk of fainting.

The active ingredient bromocriptine reaches the child via the placenta during pregnancy. Pregnant women should therefore only take the medicine if absolutely necessary. The treatment must be strictly monitored by a doctor.

The milk flow stops during the treatment. Therefore, breastfeeding women should only take bromocriptine if this effect is desired.

Patients with hepatic impairment should not take bromocriptine.

Where can I get drugs with bromocriptine?

Medicines containing bromocriptine are only available on prescription in all doses and pack sizes.

How long has bromocriptine been known?

The systematic investigation of descendants of the ergot alkaloids, which occur naturally in the ergot fungus, led to the development of bromocriptine in the 1950s and 60s. The active ingredient was introduced into clinical use in 1967. In the 1970s it was approved in many European countries. Since the patent protection has now expired, there are now several generics with the active ingredient bromocriptine on the German drug market.

Tags:  therapies hospital elderly care