Overview
Bromocriptine is a dopamine receptor agonist primarily used as an adjunct to diet and exercise for glycemic control in type 2 diabetes. It works by modulating hypothalamic dopamine activity to improve insulin sensitivity and reduce hepatic glucose production. The drug also has historical uses for hyperprolactinemia and Parkinson's disease, though the provided label focuses on its diabetes indication.
Mechanism of Action
Bromocriptine mesylate is a dopamine D2 receptor agonist that acts centrally in the hypothalamus to reset circadian dopamine activity. This action improves insulin sensitivity, reduces hepatic glucose production, and lowers postprandial glucose levels without stimulating insulin secretion.
Indications
- Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
Common Doses
- 0.8 mg
- 1.6 mg
- 2.4 mg
- 3.2 mg
- 4.0 mg
- 4.8 mg
Dosage
Typically initiated at 0.8 mg once daily within 2 hours after waking, with food. Dose may be increased weekly by 0.8 mg increments to a maximum of 4.8 mg daily based on tolerability and glycemic response.
Contraindications
- Known hypersensitivity to bromocriptine, ergot-related drugs, or any excipients
- Patients with syncopal migraine
- Postpartum patients
- Lactating patients
Side Effects
- Nausea
- Fatigue
- Dizziness
- Headache
- Somnolence
- Hypotension
- Psychiatric disturbances
- Syncope
Interactions
- Dopamine receptor antagonists (neuroleptics, metoclopramide) may reduce effectiveness
- Ergot-related drugs may increase adverse effects
- CYP3A4 inhibitors (azole antifungals, protease inhibitors) increase bromocriptine levels
- CYP3A4 inducers decrease bromocriptine levels
- Sympathomimetic drugs may cause hypertension and tachycardia
- Highly protein-bound drugs may have altered effectiveness
Counseling Points
- Take within 2 hours after waking with food
- Rise slowly from sitting/lying positions to prevent dizziness
- Avoid alcohol which may worsen side effects
- Report severe nausea, dizziness, or fainting
- Do not drive if experiencing drowsiness
- Inform healthcare provider of all medications being taken