Parlodel

Par·lo·del (pärl-dl)

A trademark for the drug bromocriptine.

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Parlodel,

trademark for a dopamine receptor agonist (bromocriptine).

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bromocriptine mesylate

Alti-Bromocriptine (CA), Apo-Bromocriptine (CA), Parlodel

Pharmacologic class: Ergot-derivative dopamine agonist

Therapeutic class: Antiparkinsonian

Pregnancy risk category B

Action

Directly stimulates dopamine receptors in hypothalamus, causing release of prolactin-inhibitory factors and thereby relieving akinesia, rigidity, and tremors associated with Parkinson's disease. Also restores testicular or ovarian function and suppresses lactation.

Availability

Capsules: 5 mg

Tablets: 2.5 mg

⊘Indications and dosages

➣ Parkinson's disease

Adults: Initially, 1.25 mg P.O. b.i.d. Increase by 2.5 mg/day q 14 to 28 days depending on therapeutic response. Usual therapeutic dosage is 10 to 40 mg/day.

➣ Acromegaly

Adults: Initially, 1.25 to 2.5 mg/day P.O. for 3 days. Increase up to 1.25 to 2.5 mg/day q 3 to 7 days. Usual therapeutic dosage is 20 to 30 mg/day.

➣ Hyperprolactinemia

Adults: Initially, 1.25 to 2.5 mg/day P.O. Increase gradually q 3 to 7 days up to 2.5 mg two to three times daily.

➣ Neuroleptic malignant syndrome

Adults: Initially, 5 mg P.O. once daily. Increase up to 20 mg/day.

➣ Pituitary tumors

Adults: Initially, 1.25 mg P.O. b.i.d. to t.i.d. Adjust dosage gradually over several weeks to a maintenance dosage of 10 to 20 mg/day given in divided doses.

Contraindications

• Hypersensitivity to drug or other ergot derivatives
• Severe peripheral vascular disease
• Uncontrolled hypertension
• Breastfeeding

Precautions

Use cautiously in:
• impaired hepatic or cardiac function, renal disease, hypertension, pituitary tumor
• psychiatric disorders
• pregnant patients
• children younger than age 15.

Administration

• Give with meals or milk.
• If desired, give at bedtime to minimize dizziness and nausea.

Route	Onset	Peak	Duration
P.O.	2 hr	8 hr	24 hr

Adverse reactions

CNS: confusion, headache, dizziness, fatigue, delusions, nervousness, mania, insomnia, nightmares, seizures, cerebrovascular accident

CV: hypotension, palpitations, extrasystoles, arrhythmias, bradycardia, acute myocardial infarction

EENT: blurred vision, diplopia, burning sensation in eyes, nasal congestion

GI: nausea, vomiting, diarrhea, constipation, abdominal cramps, anorexia, dry mouth, GI hemorrhage

GU: urinary incontinence, polyuria, urinary retention

Musculoskeletal: leg cramps

Skin: urticaria, coolness and pallor of fingers and toes, rash on face and arms, alopecia

Other: metallic taste, digital vasospasm (in acromegaly use only)

Interactions

Drug-drug. Amitriptyline, estrogens, haloperidol, hormonal contraceptives, imipramine, loxapine, MAO inhibitors, phenothiazines, progestins, reserpine: interference with bromocriptine effects

Cyclosporine: inhibition of cyclosporine metabolism, leading to cyclosporine toxicity

Erythromycin: increased bromocriptine blood level and greater risk of adverse effects

Levodopa: additive effects of bromocriptine

Risperidone: increased prolactin blood level, interference with bromocriptine effects

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatine kinase, growth hormone, uric acid: increased levels

Drug-herbs. Chaste tree fruit: decreased bromocriptine effects

Drug-behaviors. Alcohol use: disulfiram-like reaction

Patient monitoring

• Monitor blood pressure to detect hypotension.
• When giving drug for hyperprolactinemia, monitor serum prolactin.
• When giving drug for acromegaly, monitor growth hormone levels to help guide dosage adjustment.
• In long-term use, monitor respiratory, hepatic, cardiovascular, and renal function.

Patient teaching

☞ Caution patient not to drink alcohol because of risk of severe reaction.
• Advise patient to have regular dental exams. Drug causes dry mouth, possibly resulting in caries and periodontal disorders.
• To minimize constipation, instruct patient to exercise regularly, increase dietary fiber intake, and drink plenty of fluids (3,000 ml daily).
• Advise patient who doesn't desire pregnancy to use reliable contraceptive, because drug may restore fertility.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.