Dopamine Agonist — Hyperprolactinaemia
Pregnancy: Can be continued in pregnancy if required for large prolactinoma — discuss risks and benefits; established safety record
Bromocriptine (Hyperprolactinaemia)
Brand names: Parlodel
Adult dose
Dose: 1.25-2.5 mg at bedtime initially, increasing to 2.5-15 mg/day in divided doses
Route: Oral (with food)
Frequency: Two to three times daily
Max: 30 mg/day
Start low to reduce nausea; increase dose over weeks. Hyperprolactinaemia: 2.5-7.5 mg/day. Prolactinoma: 2.5-15 mg/day. Lactation suppression: 2.5 mg twice daily for 14 days (if cabergoline unavailable)
Paediatric dose
Dose: Seek specialist opinion N/A/kg
Route: Oral
Frequency: Seek specialist opinion
Max: Seek specialist opinion
Seek specialist opinion for adolescent hyperprolactinaemia
Dose adjustments
Renal
No dose adjustment required
Hepatic
Use with caution in hepatic impairment
Paediatric weight-based calculator
Seek specialist opinion for adolescent hyperprolactinaemia
Clinical pearls
- Largely superseded by cabergoline for hyperprolactinaemia — cabergoline has superior tolerability (twice-weekly dosing), fewer GI side effects, and better patient adherence
- Bromocriptine still used in pregnancy if prolactinoma requires treatment — longer safety data in pregnancy than cabergoline; stop when pregnancy confirmed (in most macroprolactinomas — continue if large with visual risk)
- MHRA: Impulse control disorders — same class warning as cabergoline; screen at every visit and document
- Postpartum lactation suppression: 2.5 mg twice daily for 14 days — MHRA 2012 restricted use due to rare cases of stroke, MI, and seizures post-partum; cabergoline preferred for safety
- Nausea management: always take with food; start at 1.25 mg at bedtime; increase slowly over 2-4 weeks — most patients tolerate well with gradual titration
Contraindications
- Uncontrolled hypertension
- Postpartum hypertension or pre-eclampsia (for lactation suppression)
- Cardiac valvular disease (high-dose long-term)
Side effects
- Nausea and vomiting (very common — especially at start)
- Dizziness and postural hypotension
- Headache
- Impulse control disorders (gambling, hypersexuality)
- Cardiac fibrosis (high doses)
- Psychosis (rare, high doses)
Interactions
- Antihypertensives (enhanced hypotension)
- Antipsychotics (antagonise dopaminergic effect)
- Erythromycin (increases bromocriptine levels via CYP3A4 inhibition)
Monitoring
- Serum prolactin (response)
- Blood pressure
- Pituitary MRI (prolactinoma)
- Impulse control behaviour
Reference: BNFc; BNF 90; MHRA Drug Safety Update 2012 (bromocriptine post-partum); Endocrine Society Prolactinoma Guidelines 2022. Verify against your local formulary and the latest BNF before prescribing.