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PubMedDate not supplied

Influence of bromocriptine on the pressor responses to afferent nervous stimulation.

The effects of intravenous bromocriptine were studied on the systolic pressor responses elicited by stimulation of afferent nerves (vagus, saphenous and superior laryngeal nerves) in urethane anaesthetized dogs. Bromocriptine alone decreased these pressor responses. Pretreatment with sulpiride failed to modify the depressor action of bromocriptine on the pressor responses to vagal stimulation. In contrast, sulpiride prevented bromocriptine-induced decrease in the pressor responses elicited by saphenous or laryngeal activation. These data confirm the potential antihypertensive properties of bromocriptine and show that this effect is only partly due to an activation of prejunctional dopaminergic receptors. They suggest that the mechanism of the antihypertensive action of bromocriptine may vary according to the level of blood pressure, the kind of arterial hypertension and the species.

Animals↗
PubMed1982

A comparative, multicenter trial between bromocriptine and amitriptyline in the treatment of endogenous depression.

A double-blind, multicenter trial compared bromocriptine (Parlodel) with amitriptyline in 83 endogenously depressed patients. The patient sample consisted mainly of agitated endogenous depression, and most of the patients were treated within a daily dose range of 30--50 mg bromocriptine or 120--200 mg amitriptyline. In both the global assessment and the Hamilton Depression Rating Scale, amitriptyline scored higher than bromocriptine, but the differences were not statistically significant. There was little difference between the drugs with respect to tolerability. Bromocriptine's potential role in psychiatry will probably be in those patients in whom an alternative treatment to standard antidepressant therapy is required and a less sedative effect with minimal anticholinergic response is indicated. Bromocriptine's use in Parkinson's disease, where the incidence of depression has been reported to be as high as 37%, has been well documented. Bromocriptine's antidepressant properties add to its therapeutic value in this disease.

Adult↗
PubMed1981

[Hypotensive action of a dopaminergic agonist, bromocriptine, in the dog].

The effects of bromocriptine administered by peripheral or central routes were studied in neurogenic hypertensive dogs. The acute hypertension was elicited by deafferentation (sino-aortic denervation). Intravenous (0,15 to 0,30 mg/kg) bromocriptine induced an important decrease in blood pressure of the debuffered dog (Fig. I). Bromocriptine reduced the arrhythmia induced by deafferentiation, but not the tachycardia of the debuffered dog (Table I). Bromocriptine was active by intracisternal route, at a dose (0,15 mg/kg) effective by intravenous route (Fig. 2). This antihypertensive effect of bromocriptine was also observed in debuffered dogs with binding of both vertebral and carotid arteries (i.e. when an effect of the drug on central structures was ruled out) (Fig. 3), and was suppressed by pretreatment with haloperidol, a dopaminergic antagonist (Fig. 4). These results imply that the mechanism underlying the hypotensive effect of bromocriptine is dopamine receptor stimulation; we consider that an effect on central nervous structures does not play a significant role in the hypotensive effect of this drug following acute intravenous administration in the dog.

Animals↗
PubMed1982

Bromocriptine and norethisterone in the treatment of premenstrual syndrome.

Thirty-six women suffering from premenstrual syndrome were treated with bromocriptine or norethisterone in a randomized placebo-controlled double-blind study. Bromocriptine decreased breast engorgement and irritability (P less than .01) and also decreased the total score of all symptoms (P less than .05). Weight gain during the luteal phase was smaller (P less than .05) during bromocriptine than during placebo treatment. Norethisterone treatment alleviated (P less than .05) breast tenderness. Changes in hormonal parameters and liver function tests during bromocriptine treatment were minimal, whereas norethisterone decreased serum levels of luteinizing hormone (P less than .01), follicle-stimulating hormone (P less than .001), and progesterone (P less than .05), while increasing the serum level of prolactin (P less than .01) and gamma-glutamyltranspeptidase activity (P less than .05). Serum levels of cholic acid and chenodeoxycholic acid remained unchanged during both therapies. Bromocriptine treatment brought about side effects in 6 and norethisterone in 3 women. At the doses used, bromocriptine appears more efficient than norethisterone with regard to premenstrual symptoms, although norethisterone is better tolerated.

Adult↗
PubMed1983

Sustained bromocriptine therapy in 50 previously untreated patients with Parkinson's disease.

The progress of 50 previously untreated patients with idiopathic Parkinson's disease taking maximum tolerated doses of bromocriptine is described. Twenty-eight showed sustained benefit, defined as a 25% improvement in disability scores for at least 1 year, and in five this improvement persisted for longer than 5 years. However, there was a tendency for deterioration to occur after about 2 years of bromocriptine. Fewer of the late complications associated with levodopa therapy were seen in those taking bromocriptine, and drug-induced dyskinesia was seen in only one patient. Fourteen early bromocriptine failures subsequently responded well to levodopa, but the addition of levodopa to patients showing late deterioration on long-term bromocriptine was unsuccessful. These results indicate that the total duration of effective drug treatment for Parkinson's disease cannot be extended by giving bromocriptine before commencing levodopa.

Bromocriptine↗
PubMed1983

Comparative efficacy of pergolide and bromocriptine in patients with advanced Parkinson's disease.

Treatment with pergolide was compared with bromocriptine in 25 patients, all of whom were also receiving levodopa and in all of whom the response to levodopa had diminished. All 25 patients had "on-off" phenomena. At the time bromocriptine was added to levodopa, the mean age of the patients was 61.8 years, mean duration of disease was 9.0 years, and mean duration of levodopa treatment was 6.1 years. For the group as a whole, disability as determined in the "on" period decreased by 36%, from 28.7 to 18.5; and 11 patients improved at least one stage. Disability as determined in the "off" period decreased by 25%, from 59.5 to 44.4. The number of hours in which patients were "on" increased by 62%, from 7.1 to 11.5. All of these changes were significant (p less than or equal to 0.05). Bromocriptine had to be discontinued in nine patients (eight because of mental changes). In the remaining 16 patients, bromocriptine was eventually discontinued because of diminishing efficacy. Mean dose of bromocriptine was 50 mg (range, 10-100 mg), and mean duration of treatment was 23 months (range, 2-65 months). At the time of their treatment with pergolide, the patients were older, 65.5 years, had the disease longer, 12.7 years, and were more disabled. Nonetheless, for the group as a whole, disability score as determined in the "on" period decreased significantly by 40%, from 43.5 to 26.3, and 14 patients improved at least one stage. Disability as determined in the "off" period decreased significantly by 21%, from 69.0 to 54.8. The number of hours in which patients were "on" increased significantly by 224%, from 3.4 to 11.0 hr. The mean dose of pergolide was 2.1 mg (range, 0.1-10.0 mg), and the mean duration of treatment was 6.2 months (range, 0.5-20 months). Pergolide was discontinued in eight patients: three because of asymptomatic tachyarrhythmias of unknown clinical significance (detected only by Holter monitoring); two because of orthostatic hypotension; and two because of mental changes. Although pergolide appears to be more potent than bromocriptine because of its greater effect in a larger number of patients at a more advanced stage of their disease, both drugs are useful, and both enhance our ability to manage patients with PD.

Aged↗
PubMedDate not supplied

[Bromocriptine in Parkinsonian syndromes. Results obtained in a group of patients treated for 8 months].

Antiparkinsonian treatment with L-Dopa gives rise to a number of problems: I) lack of initial response in a few cases; II) side-effects; III) becoming less effective after the first few years of treatment. Consequently, various drugs have been tried to replace, or combine with, L-Dopa. Among those drugs bromocriptine has been described the most effective. Twelve patients suffering from severe parkinsonism, all being intolerant to L-Dopa, have been treated with Bromocriptine. They fell into stage V of the Hoehn and Yahr's scale after 8 days of complete withdrawal of therapy with L-Dopa. Benefit and side-effects have been assessed as follows: a) L-Dopa alone; b) bromocriptine alone; c) combination of a and b. A daily dose of 30 mg of bromocriptine was given for 4 months. This was then reduced to 15 mg with the addition of L-Dopa for another 4 months. The results were: I) bromocriptine scored higher in all patients except one; II) bromocriptine has been consistently less effective than L-Dopa; III) side-effects were similar to those of L-Dopa but less frequent; IV) the combined effect of the two drugs was superior to each drug given alone.

Aged↗
PubMed1994

Bromocriptine treatment of postoperative prolactinoma patients.

BACKGROUND: Prolactinoma is the leading cause of pituitary adenoma. It causes amenorrhea in women and impotence in men. Surgical and bromocriptine treatment are the mainstays of therapy in most of the patients with this disease. Determining the outcome for postoperative hyperprolactinemia patients who received bromocriptine treatment was the main purpose of this study. METHODS: Thirty-two patients who received operation for prolactinoma have been investigated. Twenty of them had received bromocriptine treatment before conception, 14 were diagnosed as having macroadenoma and all of them had post-operative hyperprolactinemia. RESULTS: Five patients needed bromocriptine treatment of more than 12.5mg/day to decrease the serum prolactin level. Three patients received radiotherapy postoperatively. Other patients were bromocriptine sensitive. Eight of them had menses restored, and of these, five became pregnant. CONCLUSIONS: Operation can successfully treat most of the patients with microadenoma. If there has postoperative hyperprolactinemia, bromocriptine treatment should be the first choice before radiotherapy.

Adolescent↗
PubMed1995

Metoclopramide blocks bromocriptine induced antihypertensive effect in hypertensive patients.

Two groups of patients with essential hypertension were studied at the Vargas Hospital of Caracas. The first group of 9 patients under placebo treatment for 1 week received a single 2.5 mg oral dose of bromocriptine. Cardiovascular and biochemical parameters including arterial pressure, heart rate, plasma renin activity, and plasma aldosterone levels were evaluated during the 6-hour period before and after the administration of drugs. The second experimental design was as follows: 9 patients received 30 mg metoclopramide daily (divided in 3 doses) for 1 week. At the end of the period a single oral dose of 2.5 mg of bromocriptine was given to each patient. The cardiovascular and biochemical parameters were also determined. Bromocriptine reduced both systolic and diastolic arterial pressure. The peak antihypertensive effect was shown 3 hours after administration of the drug, but the reduction of arterial pressure lasted approximately 6 hours. At the same time bromocriptine reduced plasma aldosterone levels and plasma renin activity. This reduction persisted 6 hours after its administration. Metoclopramide reversed the antihypertensive effect of bromocriptine and its effect on aldosterone secretion and plasma renin activity. We conclude from these findings that bromocriptine acts as an antihypertensive agent by stimulating DA2 dopaminergic receptor, the dopaminergic receptor involved in aldosterone and renin secretion is possibly DA2.

Aldosterone↗
PubMed1998

Bromocriptine-induced tachycardia in conscious rats: blunted response following isoproterenol pretreatment for 5 days.

Previous studies have shown that tachycardia induced by intravenous injection of bromocriptine, which persisted after adrenalectomy, was mediated by central dopamine D2 receptor stimulation. Such stimulation could activate central sympathetic outflow to the heart. To test this hypothesis, we investigated whether pretreatment with isoproterenol, known to induce cardiac beta-adrenoceptor desensitization, could reduce bromocriptine-induced tachycardia. A 5 day pretreatment with isoproterenol (5 mg/kg/day) induced a 21% increase in the ratio of ventricular dry weight to body weight, compared with saline-pretreated rats. In isolated perfused heart preparations from isoproterenol-pretreated rats, the isoproterenol-induced increase in left ventricular systolic pressure and heart rate was significantly reduced, compared with saline-pretreated rats (the isoproterenol concentration producing 50% of the maximal positive inotropic and chronotropic responses was increased approximately 5- and 4-fold, respectively). In conscious control rats, intravenous injection of bromocriptine (50, 150 and 250 micrograms/kg) decreased mean aortic pressure and increased heart rate in a dose-related manner. Pretreatment with isoproterenol for 5 days reduced bromocriptine-induced tachycardia without affecting hypotension. Cardiac autonomic tone remained of the same order of magnitude irrespective of whether the animal was pretreated with isoproterenol. These results indicate that isoproterenol pretreatment reduces bromocriptine-induced tachycardia mainly through desensitization of cardiac beta-adrenoceptors rather than via an impairment of autonomic regulation of the heart. This supports the hypothesis that bromocriptine-induced activation of central dopamine D2 receptors increases heart rate via activation of central sympathetic outflow to the heart.

Adrenergic beta-Agonists↗
PubMed1982

Effects of bromocriptine on renin, aldosterone, and prolactin responses to posture and metoclopramide in idiopathic edema: possible therapeutic approach.

This study examines the effect of bromocriptine therapy (2.5 mg three times daily for 4-5 days) on orthostatic increases in weight, PRA, plasma aldosterone, and PRL in patients with idiopathic edema and in normal female controls. Additionally, PRA, aldosterone, and PRL responses to the dopamine antagonist metoclopramide were examined in both groups before and after bromocriptine. Edema patients demonstrated greater orthostatic weight gain and greater aldosterone and PRL responses to upright posture and isometric handgrip exercise. However, after bromocriptine treatment, these orthostatic responses were similar to those noted in normal controls. After metoclopramide administration, edema patients displayed normal PRA and aldosterone responses, but had exaggerated PRL responses. After bromocriptine, the PRL, but not the PRA or aldosterone, response to metoclopramide was greatly reduced. The PRL responses to metoclopramide were similar in edema patients and controls after bromocriptine treatment. These data suggest that there is decreased dopaminergic inhibition of aldosterone and PRL in response to upright posture in the idiopathic edema syndrome. Diminished orthostatic urinary excretion of sodium appears to be related to decreased dopaminergic tone in this syndrome. These abnormalities are largely corrected by tolerable doses of the dopamine agonist bromocriptine.

Adult↗
PubMedDate not supplied

Successful long-term management of a gonadotroph adenoma with bromocriptine.

OBJECTIVE: To report the successful 10-year management of a gonadotroph macroadenoma with bromocriptine and review the management of gonadotroph adenomas with bromocriptine. METHODS: We present a case and review the pertinent literature. The effectiveness of bromocriptine in the management of gonadotroph adenomas is evaluated. RESULTS: A 62-year-old man was found to have a pituitary tumor after seeking medical assistance because of a 6-month history of headaches and blurred vision. He had decreased visual acuity and bitemporal field defects. Serum follicle-stimulating hormone (FSH) levels were increased, whereas serum luteinizing hormone and total testosterone levels were normal. Treatment with bromocriptine resulted in a decrease in serum FSH levels, complete resolution of his symptoms, and considerable improvement in his visual acuity and visual field defects. Treatment with only bromocriptine for 10 years resulted in maintenance of normal serum FSH levels and no recurrence of symptoms. CONCLUSION: In the management of a gonadotroph adenoma, we recommend consideration of a therapeutic trial of bromocriptine. In cases that are refractory to this therapy, surgical treatment or external pituitary irradiation could then be used.

Journal Article↗
PubMed1995

A double-blind cross-over placebo-controlled trial of the effects of bromocriptine on psychomotor function, cognition, and mood in de novo patients with Parkinson's disease.

The effects of bromocriptine on potentially dissociable functions were investigated in this double-blind placebo-controlled trial in previously untreated Parkinsonian patients. Bromocriptine-induced reductions in response time were independent of variations in the complexity of the cognitive or motor programming components of reaction time tasks. These results suggest that bromocriptime speeds up response initiation, and it may also improve some "early" visual processes. No clear-cut verbal memory, visuospatial or general intellectual changes were produced by bromocriptine; however, further evaluation of the effects of bromocriptine on "executive" cognitive functions is clearly required. Psychiatric distress was significantly reduced when the active drug was administered. While mood improvements could not be statistically dissociated from motor improvements, review of the literature suggested that decreased emotional distress may have arisen through bromocriptine's action on neural circuits modulating mood. Some clinical implications of bromocriptine's effect on mood are mentioned.

Journal Article↗
PubMed2000

Efficacy of bromocriptine in the treatment of metastatic breast cancer- and prostate cancer-related hyperprolactinemia.

OBJECTIVE: Hyperprolactinemia is a frequent evidence occurring in both metastatic breast cancer and prostate cancer, and it has been proven to be associated with poor prognosis and reduced efficacy of the anticancer therapies. Therefore, the pharmacological control of cancer-related hyperprolactinemia could improve the prognosis of advanced breast and prostate carcinomas. Unfortunately, at present it is still controversial which may be the treatment of cancer-related hyperprolactinemia, which could depend at least in part on a direct autocrine production by cancer cells themselves. The present study was performed to evaluate the acute effects of the long-acting dopaminergic agonist bromocriptine on cancer-related hyperprolactinemia. METHODS: The study included 10 women affected by metastatic breast cancer and 10 men with metastatic prostate cancer, showing persistent hyperprolactinemia. Venous blood samples were collected before bromocriptine, and 2, 4, 10 and 24 hours after bromocriptine administration (2.5 mg orally) serum levels of PRL were measured with the double antibody RIA method. RESULTS: Bromocriptine induced a normalization of PRL levels in both groups of patients with breast and prostate cancers. Moreover, mean levels of PRL persisted significantly lower than those found before therapy during the whole 24-hour circadian period. DISCUSSION: This preliminary study shows that low-dose bromocriptine is sufficient to acutely normalize PRL secretion in both metastatic breast cancer and prostate carcinoma patients, irrespectively of the mechanisms involved in inducing cancer-related hyperprolactinemia. Therefore, low-dose bromocriptine could be recommended in association with the classical antitumor therapies in the treatment of metastatic breast cancer and prostate carcinoma patients showing cancer-related hyperprolactinemia, in an attempt to improve the efficacy of anticancer therapies themselves.

Journal Article↗
PubMed1995

Effect of Domperidone on the Bromocriptine-Induced Antihypertensive Action in Hypertensive Patients.

Dopaminergic receptors have been involved in the cardiovascular and renin-angiotensin systems (RAS). We have recently reported that bromocriptine is an effective antihypertensive drug by stimulating DA(2) dopaminergic receptors. However, the nature of the dopaminergic receptors in RAS has not been established. Ten outpatients with essential hypertension were treated at the Vargas Hospital with bromocriptine (BR) (11.25 mg day(minus sign1)), a DA(2) dopaminergic agonist, for a 2-week period, after which an oral dose of 30 mg day(minus sign1) of domperidone (DO), a peripheric DA(2) dopaminergic antagonist, was added for 2 additional weeks. The active period was preceeded by a 2-week placebo period. Bromocriptine decreased blood pressure (BP) significantly by 19/9 mm Hg (systolic/diastolic BP). Bromocriptine did not cause heart rate (HR) changes. Bromocriptine decreased plasma aldosterone (ALD) without altering plasma renin activity (PRA). Domperidone partially blocked bromocriptine-induced antihypertensive submaximal treadmill effects and reversed ALD decrease. Exercise response was not significantly altered by BR + DO. We conclude the following: (1) BR is an effective antihypertensive agent; (2) BR seems to be acting at both the central and peripheric nervous systems, and (3) the nature of the dopaminergic receptor involved in renin secretion does not seem to be DA(2).

Journal Article↗
PubMed1978

Bromocriptine in parkinsonism. A long-term study.

Bromocriptine was given in a controlled trial to 86 parkinsonian patients. Eight of 30 previously untreated patients with early and mild disease showed sustained benefit for two years and did not develop "on-off" effects or dyskinesias. Only two of 23 patients unable to tolerate or failing to respond to levodopa benefited from bromocriptine. Thirty-three patients with residual disabilities despite maximum tolerated doses of levodopa were also given bromocriptine: although benefit accrued, treatment was abandoned because of unacceptable side effects, and there was no improvement in the 11 with severe "on-off" disabilities. Although it was found that benefit from 70 mg daily of bromocriptine was comparable to that from 750 mg of levodopa with carbidopa, bromocriptine seems to offer no advantage to the majority of patients who have received or are receiving levodopa and/or carbidopa.

Anorexia↗
PubMed2000

Bromocriptine for unexplained subfertility in women.

BACKGROUND: Bromocriptine improves hyperprolactinemic amenorrhea and so could also be helpful in the treatment of unexplained subfertility in women. OBJECTIVES: To assess the effects of bromocriptine in women with unexplained subfertility. SEARCH STRATEGY: The Cochrane Subfertility Review Group specialised register of controlled trials was searched. SELECTION CRITERIA: Randomised trials comparing bromocriptine with placebo or no treatment in women with unexplained subfertility. DATA COLLECTION AND ANALYSIS: Two reviewers applied the eligibility criteria and assessed trial quality independently. MAIN RESULTS: Three trials involving of 127 women were included. All trials were double-blind comparisons with placebo, and one was of crossover design. Conception rates with bromocriptine treatment did not improve compared with placebo (odds ratio was 1.12, 95% confidence interval 0.48 to 2.57). REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate bromocriptine use in women with unexplained subfertility. However trials for women with unexplained subfertility who also have expressible galactorrhea may be worthwhile.

Bromocriptine↗
PubMed2000

Bromocriptine versus levodopa in early Parkinson's disease.

BACKGROUND: Drugs that mimic dopamine as bromocriptine were introduced as monotherapy or in a combination with LD in the hope that this approach would prevent or delay the onset of motor complications in patients with Parkinson's disease (PD). However, hitherto, the role of bromocriptine (BR) in this issue has remained controversial. The present study is a systematic review of all randomized controlled trials of bromocriptine monotherapy compared with levodopa (LD) monotherapy in PD. OBJECTIVES: To assess the efficacy and safety of bromocriptine (BR) monotherapy for delaying the onset of motor complications associated with levodopa (LD) therapy in patients with Parkinson's disease (PD). SEARCH STRATEGY: Sources including the Cochrane Library, the search strategy of the Movement Disorders Group (includes computerised searches of MEDLINE and EMBASE and hand searching of appropriate neurology journals), reference lists of the reviews found by the MEDLINE and EMBASE search-strategy, Sandoz -now Novartis- (manufacturer of BR), symposia reports, PD handbooks, contacts with colleagues who had co-ordinated trials on BR and reference lists of all included studies were used to identify randomized controlled trials (RCTs) of interest. SELECTION CRITERIA: Randomized trials were eligible for inclusion if they evaluated the efficacy of BR monotherapy for delaying the onset of motor complications compared to LD therapy in PD patients. Outcome measures that were evaluated included occurrence and severity of motor complications, changes in impairment and disability, and the occurrence of side effects. DATA COLLECTION AND ANALYSIS: To determine the feasibility of a quantitative systematic review two independent reviewers evaluated the methodological quality of identified trials. MAIN RESULTS: Over the period of 1974 to January 1999 we identified six studies randomizing more than 850 patients to a BR or a LD regimen. The majority of the studies lacked sample size calculations and randomization procedure remained unclear in three trials. Only two trials were performed according to a double-blind design. Important differences between studies concerning the duration of trials, the BR titration phase, the achieved mean dose of LD or BR, and the applied outcomes were found. Because of these differences, we could not pool the data from the different trials in an attempt to perform a meta-analysis. Therefore, the available data of the individual trials was re-analysed. Subsequently, the results were interpreted against the background of the sources of heterogeneity between the studies. The occurrence of dyskinesias in three short trials was too low to allow any conclusion. The results of the longer trials indicate a lower occurrence of dyskinesias in the BR tier. In five trials that evaluated dystonia, this motor complication occurred less frequent in the BR tier. However, for both dyskinesias and dystonia a statistically significant difference in favour of BR emerged only in the largest trial. There was a trend for wearing-off and on-off fluctuations to occur less frequently in the BR group. Although all trials evaluated patients at the impairment level, only the largest trial reported a significantly larger improvement for the LD tier during the first year of therapy. Concerning disability, which was evaluated by five trials no statistically significant differences were found. Overall, a statistically larger number of dropouts occurred in the BR group because of an inadequate therapeutic response or intolerable side effects. REVIEWER'S CONCLUSIONS: This systematic review identified important sources of heterogeneity between trials. Inadequate powering of the studies and clinically relevant differences in trial duration, applied outcomes, and trial design may explain the different results and why many findings failed to reach a statistically significant level. Nevertheless, based on qualitative review of available data we conclude that in the treatment of early Parkinson's disease, bromocriptine may be beneficial in delaying motor complications and dyskinesias with comparable effects on impairment and disability in those patients that tolerate the drug.

Antiparkinson Agents↗