Parlodel

Parlodel (bromocriptine mesylate) is a dopamine receptor agonist medication specifically formulated to address hyperprolactinemia and associated endocrine disorders. As a first-line therapeutic option, it directly targets the underlying pathophysiology of elevated prolactin levels by mimicking dopamine’s inhibitory effects on prolactin secretion from the anterior pituitary. This mechanism provides clinicians with a potent tool for restoring hormonal balance, reducing prolactinoma size, and alleviating symptoms such as galactorrhea, infertility, and menstrual irregularities. With decades of clinical use and extensive research supporting its efficacy and safety profile, Parlodel remains a cornerstone in endocrine management for appropriate patient populations.

Features

• Active ingredient: Bromocriptine mesylate 2.5mg
• Formulation: Scored tablets for precise dosing
• Mechanism: Dopamine D2 receptor agonist
• Half-life: Approximately 12-15 hours
• Bioavailability: 28% when administered orally
• Metabolism: Hepatic via CYP3A4
• Excretion: Primarily biliary (85%), renal (3-6%)

Benefits

• Rapid reduction of elevated prolactin levels within weeks of initiation
• Restoration of normal gonadal function and fertility in both men and women
• Significant reduction in prolactinoma tumor size with long-term therapy
• Effective management of galactorrhea and associated breast discomfort
• Improvement in libido and sexual function secondary to hormonal normalization
• Prevention of osteoporosis risk associated with chronic hypogonadism

Common use

Parlodel is primarily indicated for the treatment of hyperprolactinemia-associated conditions, including amenorrhea, galactorrhea, infertility, and hypogonadism. It is also approved for the management of prolactin-secreting adenomas (prolactinomas), both microadenomas (<10mm) and macroadenomas (≥10mm). Additionally, it finds application in acromegaly as adjunctive therapy to somatostatin analogs and in Parkinson’s disease for its dopaminergic effects. Off-label uses include neuroleptic malignant syndrome management and cyclic breast pain associated with menstrual cycles.

Dosage and direction

Initiate treatment with 1.25-2.5mg once daily at bedtime with food to minimize gastrointestinal side effects. Titrate gradually 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 doses. For prolactinomas, higher doses up to 30mg daily may be required. Always administer with food to enhance absorption and reduce adverse effects. Regular monitoring of prolactin levels should guide dosage adjustments, with most patients achieving normalization within 4-8 weeks.

Precautions

Monitor blood pressure regularly, especially during initial dose titration, as orthostatic hypotension may occur. Use caution in patients with hepatic impairment due to extensive hepatic metabolism. Psychiatric monitoring is recommended, particularly in patients with history of psychosis or confusion. Regular visual field testing is advised for patients with macroadenomas to assess tumor compression effects. Pregnancy testing should be performed before initiation in women of childbearing potential. Caution is warranted when operating machinery until individual response is established.

Contraindications

Hypersensitivity to ergot alkaloids or any component of the formulation. Uncontrolled hypertension, toxemia of pregnancy, or coronary artery disease. History of cardiac valvular disorders or fibrotic conditions. Concomitant use with other dopamine antagonists. Severe hepatic impairment. Psychotic disorders not adequately controlled by antipsychotic medication. Peripheral vascular disease including Raynaud’s syndrome.

Possible side effect

• Nausea (49%), vomiting (23%), headache (19%)
• Dizziness (17%), fatigue (8%), orthostatic hypotension (6%)
• Nasal congestion (10%), constipation (5%)
• Digital vasospasm (3-5%), especially in cold environments
• Dyskinesias (4%) at higher doses
• Psychiatric effects: confusion (3%), hallucinations (1%), rarely psychosis
• Rare reports of pleural effusion, pulmonary fibrosis, and cardiac valvulopathy with long-term high-dose use

Drug interaction

Strong CYP3A4 inhibitors (ketoconazole, clarithromycin) may significantly increase bromocriptine levels. Dopamine antagonists (phenothiazines, butyrophenones, metoclopramide) may diminish therapeutic effect. Concomitant use with other ergot derivatives increases risk of ergotism. Antihypertensive agents may potentiate hypotensive effects. Macrolide antibiotics and protease inhibitors may elevate bromocriptine concentrations. Alcohol may enhance CNS depression effects.

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed administration. If multiple doses are missed, contact healthcare provider for guidance on retitration, as abrupt reinitiation at previous maintenance dose may cause adverse effects. Maintain regular dosing schedule to ensure consistent prolactin suppression.

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. Supportive care including IV fluids and vasopressors for hypotension. Cardiac monitoring is recommended. There is no specific antidote; symptomatic treatment and close monitoring of vital signs are essential. Dialysis is not effective due to high protein binding.

Storage

Store at controlled room temperature (20-25°C/68-77°F) in original container. Protect from light and moisture. Keep tightly closed and away from excessive heat. Do not store in bathroom medicine cabinet due to humidity fluctuations. Keep out of reach of children and pets. Discard any medication that appears discolored or shows signs of degradation. Do not use beyond expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual response to therapy may vary. Always consult with a qualified healthcare professional before initiating or modifying any treatment regimen. Proper diagnosis and monitoring by a physician are essential for safe and effective use. Not all possible uses, interactions, or adverse effects are listed here.

Reviews

Clinical studies demonstrate 70-80% success rates in normalizing prolactin levels within 3 months of therapy. Long-term data show maintained efficacy in 85% of patients at 2-year follow-up. Patient-reported outcomes indicate significant improvement in quality of life measures related to restored fertility and reduced galactorrhea. Specialist consensus supports Parlodel as first-line therapy for microprolactinomas and adjunctive treatment for macroprolactinomas. Regular monitoring and dose individualization are emphasized in clinical guidelines for optimal outcomes.