Parlodel (bromocriptine mesylate) represents a sophisticated therapeutic approach in neuroendocrine medicine, specifically designed to address hyperprolactinemia and other dopamine-sensitive conditions. As a dopamine receptor agonist, it offers targeted intervention for hormonal imbalances through precise modulation of pituitary function. This medication has established itself as a cornerstone treatment in endocrinology and neurology practice, backed by extensive clinical research and decades of therapeutic application. Medical professionals value its specific mechanism of action and well-characterized pharmacokinetic profile for managing complex neuroendocrine disorders.

Features

• Contains bromocriptine mesylate as active pharmaceutical ingredient
• Available in 2.5mg tablet formulation with precise scoring for accurate dosing
• Dopamine D2 receptor agonist with high receptor specificity
• Rapid gastrointestinal absorption with peak plasma concentrations within 1-3 hours
• Extensive hepatic metabolism primarily via CYP3A4 enzyme system
• Mean elimination half-life of approximately 12-14 hours
• Protein binding capacity of 90-96% to serum albumin
• Manufactured under current Good Manufacturing Practices (cGMP)
• Stability-maintaining blister packaging with moisture barrier protection
• Batch-traceable manufacturing with quality control documentation

Benefits

• Effectively normalizes elevated prolactin levels through dopamine receptor activation
• Restores gonadal function and fertility in hyperprolactinemic patients
• Reduces prolactinoma tumor size in approximately 50-60% of macroprolactinomas
• Alleviates galactorrhea symptoms and associated discomfort
• Improves menstrual regularity and ovulatory function in female patients
• Enhances testosterone production and sexual function in male patients

Common use

Parlodel is primarily indicated for the treatment of hyperprolactinemia-associated conditions, including amenorrhea, galactorrhea, infertility, and hypogonadism. It is extensively used in the management of prolactin-secreting adenomas (prolactinomas), both microadenomas and macroadenomas. Additionally, it finds application in Parkinson’s disease therapy as adjunctive treatment, though this represents a secondary indication. Off-label uses include acromegaly management when combined with somatostatin analogs, and in some cases of neuroleptic malignant syndrome. The medication’s ability to cross the blood-brain barrier makes it particularly valuable for central nervous system-related endocrine disorders.

Dosage and direction

Initiate treatment with 1.25-2.5mg once daily, preferably with food to minimize gastrointestinal discomfort. Gradually titrate upward by 2.5mg increments every 3-7 days based on prolactin level response and tolerance. Maintenance doses typically range from 2.5mg to 15mg daily, divided into two or three administrations. For prolactinoma management, maximum doses may reach 30mg daily in divided doses. Administer with the evening meal when starting therapy to mitigate potential orthostatic hypotension. Regular monitoring of prolactin levels should guide dosage adjustments, with therapeutic goals typically achieved within 4-8 weeks of optimal dosing.

Precautions

Exercise caution in patients with cardiovascular disease, particularly those with history of myocardial infarction or arrhythmias. Monitor blood pressure regularly during initial titration phase due to risk of orthostatic hypotension. Use cautiously in patients with hepatic impairment, as bromocriptine undergoes extensive hepatic metabolism. Psychiatric history requires careful assessment before initiation and during treatment. Perform periodic visual field testing in prolactinoma patients, particularly those with macroadenomas. Caution advised in patients taking medications that affect CYP3A4 activity. Elderly patients may require slower titration and more frequent monitoring.

Contraindications

Hypersensitivity to bromocriptine, ergot alkaloids, or any component of the formulation. Uncontrolled hypertension, toxemia of pregnancy, or postpartum hypertension. Severe ischemic heart disease or peripheral vascular disorders. History of psychotic disorders requiring antipsychotic medication. Concurrent use with macrolide antibiotics or potent CYP3A4 inhibitors without appropriate dose adjustment. Hepatic failure or severe hepatic impairment. Untreated pituitary tumors with mass effect symptoms requiring surgical intervention.

Possible side effect

• Nausea (40-50% of patients, typically dose-dependent)
• Headache (25-30%, often diminishing with continued therapy)
• Dizziness and orthostatic hypotension (20-25%, particularly during initiation)
• Fatigue and drowsiness (15-20%)
• Nasal congestion (10-15%)
• Constipation or abdominal discomfort (10-12%)
• Vomiting (8-10%, usually transient)
• Digital vasospasm (5-8% with higher doses)
• Psychiatric effects including confusion or hallucinations (2-5%, dose-related)
• Dyskinesias in Parkinson’s patients (dose-dependent)

Drug interaction

Potent CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin) may significantly increase bromocriptine concentrations. Dopamine antagonists (phenothiazines, butyrophenones, metoclopramide) may diminish therapeutic effect. Antihypertensive agents may potentiate hypotensive effects. Ergot derivatives may increase risk of ergotism. Sympathomimetic agents may theoretically increase blood pressure, though clinical significance is uncertain. Oral contraceptives may require adjustment based on prolactin level monitoring. Alcohol may enhance CNS depressant effects and orthostatic hypotension.

Missed dose

If a dose is missed within 4 hours of scheduled time, administer as soon as remembered. If more than 4 hours have passed, skip the missed dose and resume regular dosing schedule. Do not double the next dose to compensate for missed administration. Maintain consistent timing of doses to ensure stable dopamine receptor stimulation. For patients on multiple daily doses, adjust subsequent doses to maintain total daily dosage while avoiding dose stacking. Document missed doses in medication adherence records.

Overdose

Symptoms may include severe nausea, vomiting, hypotension, confusion, hallucinations, and profound hypotension. Management involves immediate gastric lavage if ingestion occurred within 2 hours, followed by activated charcoal administration. Supportive care includes maintenance of blood pressure with intravenous fluids and vasopressors if necessary. Control nausea and vomiting with antiemetics that don’t antagonize dopamine receptors. Monitor cardiac function and neurological status continuously. There is no specific antidote; hemodialysis is not effective due to high protein binding. Contact poison control center for latest management recommendations.

Storage

Store at controlled room temperature (20-25°C/68-77°F) in original packaging. Protect from moisture and light exposure. Keep blister strips sealed until immediately before administration. Do not transfer to alternative containers as moisture protection may be compromised. Avoid storage in bathrooms or areas with high humidity. Keep securely closed and out of reach of children and pets. Do not use if packaging appears compromised or tablets show signs of moisture damage. Discard unused medication properly according to local regulations.

Disclaimer

This information is provided for educational purposes and does not constitute medical advice. Treatment decisions must be made by qualified healthcare professionals based on individual patient assessment. Dosage and administration should follow approved prescribing information. Patients should not adjust therapy without medical supervision. The prescribing physician should be aware of complete medical history and concurrent medications. Regular monitoring is essential during therapy. Efficacy and safety profiles are based on clinical trial data and post-marketing experience.

Reviews

Clinical studies demonstrate prolactin normalization in 80-90% of microprolactinoma patients within 8-12 weeks of therapy. Long-term follow-up shows maintained efficacy in 70-80% of patients with appropriate dose adjustment. Macroadenoma patients exhibit tumor size reduction in approximately 60% of cases, with visual field improvement correlating with size reduction. Patient-reported outcomes indicate significant improvement in quality of life measures related to restored gonadal function and symptom resolution. Tolerance generally improves with gradual titration and continued therapy, though individual response varies. Monitoring of cardiac valves recommended with long-term high-dose therapy based on ergot-related compound precautions.