Dopamine Agonist — Hyperprolactinaemia Pregnancy: If pregnancy occurs it is generally advisable to withdraw bromocriptine after the first missed menstrual period. Based on outcomes of more than 2,000 pregnancies, use of bromocriptine 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, with monitoring for pituitary enlargement. Because 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 (Hyperprolactinaemia)

Brand names: Parlodel

This page concerns bromocriptine, an ergot-derived dopamine agonist, used to treat hyperprolactinaemia, including prolactin-secreting pituitary adenomas and associated infertility or galactorrhoea.

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: Hypogonadism / galactorrhoea syndromes / infertility: most patients with hyperprolactinaemia have responded to 7.5 mg daily in divided doses, reached by gradual introduction. Introduce gradually: initially 1 mg to 1.25 mg at bedtime, increasing after 2 to 3 days to 2 mg to 2.5 mg at bedtime, then increase by 1 mg at 2 to 3 day intervals until 2.5 mg twice daily is achieved; further increments added in a similar manner

Route: Oral — always take with food

Frequency: In divided doses (the titration scheme starts once daily at bedtime and builds to twice daily; higher hyperprolactinaemia doses are given in divided doses)

Max: Doses of up to 30 mg daily have been used in hypogonadism/galactorrhoea/infertility. For prolactinomas and Parkinson's disease the SPC states daily doses should not exceed 30 mg.

Source: UK SPC for Bromocriptine 2.5 mg tablets (§4.2). Bromocriptine should always be taken with food; in most indications the optimum response with fewest side effects is best achieved by gradual introduction. In infertile patients WITHOUT demonstrably elevated serum prolactin levels the usual dose is 2.5 mg twice daily. OTHER LABELLED REGIMENS — Prevention of lactation: 2.5 mg on the day of delivery followed by 2.5 mg twice daily for 14 days, instituted within a few hours of parturition once vital signs have stabilised (gradual introduction 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 not necessary). 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 — 2.5 mg eight-hourly, 2.5 mg six-hourly, 5 mg six-hourly. Parkinson's disease: week 1 1–1.25 mg at bedtime, week 2 2–2.5 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; usual optimum 10–30 mg daily, not exceeding 30 mg. PAEDIATRIC (not per-kg, so paedDose is null): prescribing in children and adolescents aged 7–17 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. Verify all paediatric dosing against a children's formulary before prescribing. Hepatic impairment: elimination may be retarded and plasma levels increase, requiring dose adjustment. Elderly: no clinical evidence of special risk. Initial nausea/vomiting may be reduced by taking bromocriptine during a meal and, if necessary, a peripheral dopamine antagonist such as domperidone for a few days, at least one hour before the bromocriptine dose.

Dose adjustments

Renal

No renal dose adjustment is stated in the source SPC. Hepatic impairment: the speed of elimination may be retarded and plasma levels may increase, requiring dose adjustment.

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.

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 (uncommon), which may in very rare instances lead to collapse
Confusion, psychomotor agitation, hallucinations (uncommon); psychotic disorders and insomnia (rare)
Cardiac valvulopathy including regurgitation, pericarditis and pericardial effusion (very rare); pleural effusion, pleural and pulmonary fibrosis, retroperitoneal fibrosis (rare)
In postpartum women treated for prevention of lactation, extremely rare serious events including hypertension, myocardial infarction, convulsion, stroke or mental disorders — sometimes preceded by severe headache and/or transient visual disturbance

Interactions

Vasoconstrictors such as sympathomimetics, or ergot alkaloids including ergometrine or methylergometrine, during the puerperium — concomitant use is not recommended (§4.4)
Drugs that can alter blood pressure — particular caution if given concomitantly or recently; monitor blood pressure carefully, especially during the first days of therapy (§4.4)
Dopamine antagonists — phenothiazines, haloperidol, metoclopramide, pimozide and butyrophenones decrease the efficacy of bromocriptine (US label)
Strong CYP3A4 inhibitors (bromocriptine is a CYP3A4 substrate) — e.g. azole antimycotics, HIV protease inhibitors; macrolides such as erythromycin increased bromocriptine AUC 3.7-fold and Cmax 4.6-fold (US label)
Octreotide — increased bromocriptine plasma levels (AUC increased about 38%) in acromegalic patients (US label)
Alcohol may potentiate the side effects of bromocriptine (US label)

Clinical monograph

How it works

It stimulates dopamine D2 receptors on pituitary lactotroph cells, suppressing prolactin secretion and often shrinking prolactinomas.

Prescribing in practice

Symptomatic postural hypotension can occur, especially at initiation, so it should be titrated gradually and taken with food, with caution in cardiovascular disease.
As fertility may be restored quickly, contraceptive and pregnancy plans should be discussed, and specialist advice sought regarding continuation in pregnancy.
Ergot-related effects including nausea, and rarely fibrotic and psychiatric reactions, warrant vigilance, and concomitant strong dopamine antagonists oppose its action.

Monitoring

Monitor serum prolactin, symptom control, blood pressure and, for macroadenomas, pituitary imaging and visual fields as indicated.

Counselling the patient

Rise slowly from sitting or lying as dizziness is common at first, and take doses with food.
Be aware fertility may return, so discuss contraception or pregnancy plans.
Report persistent headache, visual changes, mood changes or breathlessness.

Evidence & guidelines

Dopamine agonists are first-line for hyperprolactinaemia, with bromocriptine long established for lowering prolactin and restoring fertility.

Reference: MHRA Drug Safety Update 2012 (bromocriptine post-partum); Endocrine Society Prolactinoma Guidelines 2022; 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).