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Dopamine Agonist (D2 Receptor) / Prolactin Inhibitor Pregnancy: Can be continued in pregnancy if macroprolactinoma with high expansion risk — more pregnancy safety data than cabergoline. Stop at conception in microprolactinoma. Seek specialist advice.

Bromocriptine

Brand names: Parlodel

Adult dose

Dose: Hyperprolactinaemia: 1–1.25mg at bedtime initially; increase gradually every 2–4 weeks to 7.5–15mg daily in divided doses. Acromegaly (adjunct): 10–30mg daily in divided doses. Parkinson's disease: 1.25mg OD increasing to 10–40mg daily (specialist neurology dosing).
Route: Oral
Frequency: Two to three times daily (with meals)
Max: 30mg daily (hyperprolactinaemia); 40mg daily (Parkinson's — specialist)
Take with food at bedtime initially to reduce nausea and first-dose hypotension. Now largely superseded by cabergoline for hyperprolactinaemia due to twice-weekly dosing advantage and better tolerability. Still used in some cases of resistance, during pregnancy (more safety data than cabergoline), and in acromegaly as adjunct.

Paediatric dose

Route: Oral
Frequency: Two to three times daily
Max: Individualised
Seek specialist paediatric endocrinology opinion. Used in adolescent prolactinomas — cabergoline generally preferred where available.

Dose adjustments

Renal

No specific dose adjustment — use with caution in renal impairment.

Hepatic

Severe hepatic impairment: reduce dose — extensively hepatically metabolised.

Clinical pearls

  • More safety data in pregnancy than cabergoline — some centres use bromocriptine preferentially in women with prolactinoma who are pregnant or planning pregnancy
  • Postpartum: bromocriptine used historically for lactation suppression but withdrawn from this indication in most countries due to hypertension/stroke risk — use cabergoline 1mg single dose instead
  • Nausea management: always start at lowest dose at bedtime; titrate very slowly over weeks — tolerance develops
  • Acromegaly: bromocriptine reduces GH in ~10–20% of acromegaly patients (less effective than somatostatin analogues); used as adjunct

Contraindications

  • Hypersensitivity to bromocriptine or ergot alkaloids
  • Uncontrolled hypertension
  • History of puerperal psychosis
  • Cardiac valvulopathy (high-dose use)
  • History of fibrotic disorders

Side effects

  • Nausea and vomiting (very common)
  • Dizziness, orthostatic hypotension
  • Headache
  • Nasal congestion
  • Raynaud's phenomenon
  • Impulse control disorders
  • Retroperitoneal / pleuropulmonary fibrosis (high doses)
  • Psychiatric symptoms (high doses — Parkinson's use)

Interactions

  • Antipsychotics, metoclopramide — antagonise effect
  • Antihypertensives — additive hypotension
  • Erythromycin — increases bromocriptine levels

Monitoring

  • Serum prolactin
  • Blood pressure (particularly at initiation)
  • MRI pituitary
  • Visual fields (macroprolactinoma)

Reference: BNFc; BNF 90; Endocrine Society Prolactinoma Guidelines 2011. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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