Parlodel

[pahr´lo-del]

trademark for a preparation of bromocriptine mesylate, a dopamine agonist used to suppress prolactin secretion and to treat parkinsonism and acromegaly.

bromocriptine mesylate

Apo-Bromocriptine (CA), Cycloset, Dom-Bromocriptine (CA),Parlodel, PMS-Bromocriptine (CA)

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. Cycloset's action in glycemic control is unknown.

Availability

Capsules: 5 mg

Tablets: 0.8 mg, 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; not to exceed 100 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.

➣ Type 2 diabetes mellitus

Adults: Initially, 0.8 mg P.O. daily within 2 hours of awakening; may increase by one tablet (0.8 mg) weekly until target range (1.6 to 4.8 mg) or maximal tolerance is reached.

Contraindications

• Hypersensitivity to drug, its components, or other ergot-related drugs

• Severe peripheral vascular disease

• Uncontrolled hypertension, syncopal migraines

• Breastfeeding

Precautions

Use cautiously in:

• impaired hepatic or cardiac function, renal disease, hypertension, pituitary tumor

• psychiatric disorders

• galactose intolerance, severe lactose deficiency, glucose-galactose malabsorption (use not recommended)

• Concomitant use with anti-hypertensives

• Concomitant use with dopamine antagonists such as neuroleptic agents (use not recommended)

• pregnant patients

• children younger than age 15.

Administration

• Give with meals or milk.

• If desired, give at bedtime to minimize dizziness and nausea.

• For Cycloset, administer within 2 hours of patient's waking in the morning and with food.

Adverse reactions

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

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

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

GI: dyspepsia, 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), infection

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

Dopamine receptor antagonists (such as neuroleptics [including phenothiazines, butyrophenones, thioxanthenes]), metoclopramide: diminished effectiveness of Cycloset and these drugs

Ergot-related drugs: increased ergotrelated adverse reactions, such as nausea, vomiting, and fatigue; decreased effectiveness of these drugs

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

Levodopa: additive effects of bromocriptine

Potent CYP3A4 inhibitors or inducers, substrates of CYP3A4 (such as azole antimycotics, HIV protease inhibitors): increased or decreased Cycloset circulating levels

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.

• When giving drug for diabetes mellitus, monitor blood glucose and hemoglobin A1C levels.

• In long-term use, monitor respiratory, hepatic, cardiovascular, and renal function.

Patient teaching

• Instruct patient to take Cycloset within 2 hours of waking in the morning and with food.

☞ 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.

Parlodel

(pär′lə-dĕl′)

A trademark for the drug bromocriptine mesylate.

bromocriptine

Endocrinology
An ergoline derivative which reduces pituitary prolactin secretion and size of pituitary tumours.

Indications
Hyperprolactinemia, pituitary tumours, amenorrhoea, female infertility, hypogonadism, acromegaly, Parkinson’s disease, neuroleptic malignant syndrome, type-2 diabetes.

Adverse effects
Orthostatic hypotension, vomiting, vertigo, headaches, upset stomach, coronary vasospasm, pulmonary fibrosis, hepatotoxicity.

Immunology
A dopamine D2-receptor inhibitor which inhibits T-cell-dependent induction of macrophage tumouricidal activity.

Parlodel

A brand name for BROMOCRIPTINE.

Mentioned in

References in periodicals archive

Glastetter's expert physicians were not scientifically valid "because they lacked a proper basis for 'ruling in' Parlodel as a potential cause of ICH in the first place." (57) The Eighth Circuit then reviewed with particularity and affirmed the district court's findings on each of the separate lines of causation evidence proffered by the plaintiffs' experts.

Manning the Daubert gate: a defense primer in response to Milward v. Acuity Specialty Products

"Parlodel is widely used to treat Parkinson's Disease and endocrine disorders," Rothwell says.

Sandoz retreats

scant attention to Parlodel, the second example we use to support our

From the wrong end of the telescope: a response to professor David Bernstein

If there is a distinction I believe justifies my existence on Earth, it is this: I am personally responsible [or three national recalls--by Remington Arms, Honda, and Parlodel drugs.

The good that trial lawyers do

For bromocriptine (Parlodel), it's 20-25 mg/day Often used as levodopa-sparing agents, the dopamine agonists also improve response when combined with Sinemet, particularly late in the disease.

Eight key points for treating Parkinson's disease. (Clinical Rounds: Primary care should take charge)

2000), rejecting the necessity for epidemiological evidence in a case involving an acute myocardial infarction allegedly caused by ingestion of Parlodel, a lactation suppression drug, disagreed sharply with other courts in evaluating the same kind of evidence because "the Daubert standard [in those cases] was applied incorrectly, creating much too high a standard of admissibility.

Scientific ignorance and reliable patterns of evidence in toxic tort causation: is there a need for liability reform?

Clinical commentary: the bromocriptine (Parlodel) controversy and recormendations for lactation suppression.

Postpartum psychosis induced by bromocriptine and pseudoephedrine

resulting harm concerns Parlodel, an anti-lactation drug taken after

Uncertainty and informed choice: unmasking Daubert

2003), in which the plaintiffs tried to rely on a Food and Drug Administration determination that the drug Parlodel "might cause seizures or strokes in women already susceptible to disease." The court held that the FDA's determination was not sufficient evidence of causation, explaining that the balancing of risks employed by the agency was different from the threshold standard for establishing causation in tort cases:

Conning the IADC newsletters

(6.) The following litany from the Daubert hearing in a products liability cause involving the drug Parlodel illustrates this approach: "The scientific method entails accumulating scientific data to formulate a hypothesis; observing, experimenting with, and testing that hypothesis; reviewing new data to come to a general conclusion about the phenomena being studied; and then repeating the process again and again to get closer to a true relationship." Hearing transcript, vol.

Learn the science in your cases: something has gone wrong with Daubert. To fix it, courts must first acknowledge that science cannot be defined simply

These cost less than the first-generation agents Permax (pergolide) and Parlodel (bromocriptine).

Delay Levodopa in Young Parkinson's Patients

Artane, Kemadrin, Benadryl, Atkineton, Parlodel, Permax, Eldepryl Antianxiety and Hypnotic Agents - Librium, Valium, Dalmane,

Managing disruptive behavioral symptoms: today's do's and don't's