Dopamine Agonist (D2 Receptor) / Prolactin Inhibitor Pregnancy: If pregnancy occurs it is generally advisable to withdraw bromocriptine after the first missed menstrual period; patients should be monitored for signs of pituitary enlargement so that it can be reintroduced if necessary. Based on more than 2,000 pregnancies, use to restore fertility has not been associated with an increased risk of abortion, premature delivery, multiple pregnancy or malformation; maintenance during pregnancy may be considered where there is a large tumour or evidence of expansion. Since bromocriptine inhibits lactation it should not be given to mothers who elect to breast-feed. Fertility may be restored by treatment — women of childbearing age who do not wish to conceive should use reliable contraception.

Bromocriptine

Brand names: Parlodel

Bromocriptine is an ergot-derived dopamine agonist used for hyperprolactinaemia and acromegaly, and sometimes for lactation suppression (with caution). It is used under specialist care.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: General gradual-introduction scheme: 1 mg to 1.25 mg at bedtime initially, increasing after 2 to 3 days to 2 mg to 2.5 mg at bedtime, then by 1 mg at 2 to 3 day intervals until 2.5 mg twice daily is achieved; further increments added in the same manner according to indication

Route: Oral — always take with food

Frequency: Initially once daily at bedtime, then in divided doses (typically twice daily, up to 6-hourly for pituitary indications)

Max: Daily doses should not exceed 30 mg (stated for prolactinomas and for Parkinson's disease)

A number of disparate conditions are treated with bromocriptine, so the recommended dosage regimens are variable; in most indications the optimum response with the minimum of side effects is best achieved by gradual introduction. INDICATION-SPECIFIC REGIMENS (SPC §4.2): Prevention of lactation — 2.5 mg on the day of delivery, followed by 2.5 mg twice daily for 14 days; treatment should be instituted within a few hours of parturition once vital signs have stabilised; gradual introduction is not necessary. Suppression of lactation for medical reasons — 2.5 mg on the first day, increasing after 2 to 3 days to 2.5 mg twice daily for 14 days; gradual introduction is not necessary. Hypogonadism/galactorrhoea syndromes/infertility — introduce gradually per the scheme; most patients with hyperprolactinaemia have responded to 7.5 mg daily in divided doses, but doses of up to 30 mg daily have been used; in infertile patients without demonstrably elevated serum prolactin the usual dose is 2.5 mg twice daily. Prolactinomas — introduce gradually, then increase by 2.5 mg daily at 2 to 3 day intervals as follows: 2.5 mg eight hourly, 2.5 mg six hourly, 5 mg six hourly; daily doses should not exceed 30 mg. Acromegaly — introduce gradually, then increase by 2.5 mg at 2 to 3 day intervals as follows: 2.5 mg eight-hourly, 2.5 mg six-hourly, 5 mg six-hourly. Parkinson's disease — week 1: 1 mg to 1.25 mg at bedtime; week 2: 2 mg to 2.5 mg at bedtime; week 3: 2.5 mg twice daily; week 4: 2.5 mg three times daily; thereafter three times a day increasing by 2.5 mg every 3 to 14 days depending on response, usually to between 10 mg and 30 mg daily; daily doses should not exceed 30 mg. In patients already receiving levodopa, the levodopa dose may be decreased gradually as bromocriptine is increased. CHILDREN AND ADOLESCENTS (aged 7–17) — prescribing should be limited to Paediatric Endocrinologists. Prolactinomas, 7 years and older: 1 mg 2 or 3 times daily, gradually increasing to several tablets daily as required to keep plasma prolactin adequately suppressed; maximum daily dose 5 mg in children aged 7 to 12 years and 20 mg in adolescents aged 13 to 17 years. Gigantism (acromegaly), 7 years and older: starting dose titrated in response to growth hormone levels; maximum daily dose 10 mg in children aged 7 to 12 years and 20 mg in adolescents aged 13 to 17 years. (These paediatric doses are fixed mg doses, not per-kg, so they are recorded here rather than in paedDose.) Elderly: no clinical evidence of special risk. Hepatic impairment: elimination may be retarded and plasma levels may increase, requiring dose adjustment. Initial nausea and/or vomiting may be reduced by taking bromocriptine during a meal and, if necessary, by a peripheral dopamine antagonist such as domperidone for a few days, given at least one hour before bromocriptine.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION General It is recommended that bromocriptine mesylate be taken with food. Patients should be evaluated frequently during dose escalation to determine the lowest dosage that produces a therapeutic response. Hyperprolactinemic Indications The initial dosage of bromocriptine mesylate tablets in adults is half to one 2.5 mg scored tablet daily. An additional 2.5 mg tablet may be added to the treatment regimen as tolerated every 2 to 7 days until an optimal therapeutic response is achieved. The therapeutic dosage ranged from 2.5-15 mg daily in adults studied clinically. Based on limited data in children of age 11 to 15, (see Pediatric Use) the initial dose is half to …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-05-31. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to bromocriptine, to any of the excipients, or to other ergot alkaloids
Uncontrolled hypertension; hypertensive disorders of pregnancy (including eclampsia, pre-eclampsia or pregnancy-induced hypertension); hypertension postpartum and in the puerperium
Suppression of lactation or other non-life-threatening indications in patients with a history of coronary artery disease or other severe cardiovascular conditions, or symptoms/history of severe psychiatric disorders
For long-term treatment: evidence of cardiac valvulopathy as determined by pre-treatment echocardiography

Side effects

Nausea and constipation (common); vomiting and dry mouth (uncommon)
Headache and drowsiness (common); dizziness and dyskinesia (uncommon); excess daytime somnolence and sudden sleep onset (very rare)
Nasal congestion (common)
Hypotension including orthostatic hypotension, which may very rarely lead to collapse (uncommon)
Confusion, psychomotor agitation, hallucinations (uncommon); psychotic disorders, insomnia (rare)
Cardiac valvulopathy including regurgitation, pericarditis and pericardial effusion (very rare); pleural effusion, pleural and pulmonary fibrosis, retroperitoneal fibrosis (rare)

Interactions

eMC §4.5 was not retrieved in this bundle — the entries below are from the SPC §4.4 and from US labelling, and must be checked against the UK SPC §4.5
Concomitant use with vasoconstrictors such as sympathomimetics or ergot alkaloids including ergometrine or methylergometrine during the puerperium is not recommended (§4.4)
Particular caution in patients on, or recently treated with, drugs that can alter blood pressure (§4.4)
US labelling: dopamine antagonists reduce the efficacy of bromocriptine — phenothiazines, haloperidol, metoclopramide, pimozide, butyrophenones
US labelling: bromocriptine is a CYP3A4 substrate — caution with strong CYP3A4 inhibitors (azole antimycotics, HIV protease inhibitors); erythromycin increased bromocriptine AUC 3.7-fold and Cmax 4.6-fold; octreotide increased bromocriptine AUC by about 38%
US labelling: alcohol may potentiate side effects; concomitant use with other ergot alkaloids is not recommended

Clinical monograph

How it works

It is a dopamine D2 receptor agonist; stimulating pituitary dopamine receptors inhibits prolactin secretion and can reduce growth hormone in acromegaly.

Prescribing in practice

Fibrotic reactions (pulmonary, retroperitoneal and cardiac valve) can occur, particularly with prolonged or higher-dose use.
Psychiatric effects and impulse-control disorders (e.g. pathological gambling, hypersexuality) may develop.
Postural hypotension can occur, especially on initiation; introduce gradually.

Monitoring

Monitor prolactin and clinical response; remain alert for fibrotic reactions, psychiatric changes and impulse-control symptoms.

Counselling the patient

Tell your clinician about new urges such as gambling or changes in sexual behaviour.
Report breathlessness, persistent cough or chest pain.
Rise slowly from sitting or lying to reduce dizziness.

Evidence & guidelines

Established dopamine agonist; used under specialist supervision per the SPC.

Reference: Endocrine Society Prolactinoma Guidelines 2011; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Cabergoline · Dopamine Agonist (D2 Receptor) / Prolactin Inhibitor

Pathways