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Bromocriptine

Classification: A

Drug products: Parlodel, Pravidel, Pravidel®

ATC code: G02CB01, N04BC01

Substances: bromocriptine, bromocriptine mesylate

Summary

Controlled trials of differences between men and women in the effect of bromocriptine are lacking.

The main indication of bromocriptine is in combination with L-dopa in Parkinson’s disease. The substance is also used to abort lactation. Bromocriptine is also used for treatment of prolactinoma, tumor size has been shown to diminish similarly in men and women with macroadenomas.

The frequency of bromocriptine-resistant tumors seems to be higher in men. Bromocriptine is also used in the treatment of peri-partum cardiomyopathy.

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 the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Updated: 2020-03-18

Date of litterature search: 2019-11-26

References

  1. Parlodel (bromocriptine). DailyMed [www]. US National Library of Medicine. [updated 2018-12-11, cited 2019-11-26]. länk
  2. 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
  3. 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
  4. 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
  5. 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
  6. Nishioka H, Haraoka J, Akada K, Azuma S. Gender-related differences in prolactin secretion in pituitary prolactinomas. Neuroradiology. 2002;44(5):407-10. PubMed
  7. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2019 [cited 2020-03-10.] länk

Authors: Linnéa Karlsson Lind

Reviewed by: Mia von Euler, Carl-Olav Stiller

Approved by: Karin Schenck-Gustafsson