Bromokriptin
Klassificering: AATC kod: G02CB01, N04BC01
Sammanfattning
Det saknas kontrollerade studier om könsskillnader avseende effekt för bromokriptin.
Huvudindikationen för bromokriptin är kombinationsbehandling med L-dopa vid Parkinsons sjukdom och för avbrytande av amning. Bromokriptin används även vid behandling av prolaktinom, där tumörstorleken minskar hos både kvinnliga och manliga patienter med macroadenom.
Frekvensen av bromokriptin-resistenta tumörer tycks vara signifikant högre hos män än hos kvinnor. Bromokriptin används även för behandling av peri-partum kardiomyopati.
Additional information
Bromocriptine is mainly indicated for treatment of Parkinson’s disease in combination with levodopa. Furthermore, bromocriptine is indicated in patients with prolactin-secreting adenomas (hyperprolactinemia), reduction in tumor size has been seen in both men and women with macroadenomas. Bromocriptine is also indicated in women needing to terminate lactation and in treatment of acromegaly [1].
Pharmacokinetics and dosing
The impact of patient’s age and sex on bromocriptine pharmacokinetics and its metabolites has not been evaluated by the pharmaceutical company [1]. No published studies with a clinically relevant sex analysis regarding the pharmacokinetics or dosing of bromocriptine have been found.
Effects
No studies with a clinically relevant sex analysis regarding the effects of bromocriptine have been found.
Bromocriptine has been investigated for treatment of peripartum cardiomyopathy in women. Prolactin is considered as essential in the pathophysiology of the disease. Addition of bromocriptine to standard heart failure therapy improved left ventricular ejection fraction in these women [2, 3].
Adverse effects
Bromocriptine-resistant prolactinomas have in most studies been found to be more frequent in men than in women. This sex difference is not directly explained by the predominance of large tumors in men, as the tumor size is not predictive of the response to bromocriptine therapy. This finding has been reported in several studies [4-6].
Reproductive health issues
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept
Fler kvinnor än män hämtade ut tabletter innehållande bromokriptin (ATC-kod G02CB01) på recept i Sverige år 2019, totalt 2 432 kvinnor och 591 män. Det motsvarar 0,5 respektive 0,1 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 25-39 år hos kvinnor och i åldersgruppen 80 år och äldre hos män. Totalt sett var tabletter innehållande bromokriptin 4,4 gånger vanligare hos kvinnor [7].
Uppdaterat: 2020-08-28
Litteratursökningsdatum: 2019-11-26
Referenser
- Parlodel (bromocriptine). DailyMed [www]. US National Library of Medicine. [updated 2018-12-11, cited 2019-11-26]. länk
- Hilfiker-Kleiner D, Haghikia A, Berliner D, Vogel-Claussen J, Schwab J, Franke A et al. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J. 2017;38(35):2671-2679. PubMed
- Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation. 2010;121(13):1465-73. PubMed
- Delgrange E, Trouillas J, Maiter D, Donckier J, Tourniaire J. Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study. J Clin Endocrinol Metab. 1997;82:2102-7. PubMed
- Delgrange E, Sassolas G, Perrin G, Jan M, Trouillas J. Clinical and histological correlations in prolactinomas, with special reference to bromocriptine resistance. Acta Neurochir (Wien). 2005;147:751-7; discussion 757-8. PubMed
- Nishioka H, Haraoka J, Akada K, Azuma S. Gender-related differences in prolactin secretion in pituitary prolactinomas. Neuroradiology. 2002;44(5):407-10. PubMed
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.] länk
Faktagranskat av: Mia von Euler, Carl-Olav Stiller
Godkänt av: Karin Schenck-Gustafsson