Section 03 · Monograph

Bromocriptine

Reviewed Nov 2026FDA label

ParlodelDopamine agonist

Indications

Treatment of signs and symptoms of idiopathic or postencephalitic Parkinson's disease, as adjunctive therapy (e.g., with levodopa) or for patients experiencing tolerance/motor fluctuationsFDA-labeled
Hyperprolactinemia-associated dysfunctions: amenorrhea with or without galactorrhea, infertility, and hypogonadism; prolactin-secreting adenomasFDA-labeled
Acromegaly (reduction of growth hormone levels)FDA-labeled

Ergot-derivative (ergoline) dopamine receptor agonist that directly stimulates dopamine D2 receptors in the corpus striatum, compensating for the progressive dopaminergic deficiency of Parkinson's disease
Also acts on pituitary lactotroph D2 receptors to inhibit prolactin secretion via the tuberoinfundibular pathway
In acromegaly, activation of hypothalamic/pituitary dopamine receptors suppresses growth hormone secretion

Parkinson's disease: initiate at 1.25 mg (half of a 2.5 mg tablet) twice daily with meals
Titrate dose upward every 14–28 days by increments of 2.5 mg/day as needed and tolerated, based on clinical response
Doses above 100 mg/day have not been systematically evaluated for safety in Parkinson's disease
Reassess clinical response at approximately 2-week intervals during titration

Hypersensitivity to bromocriptine or other ergot alkaloids
Uncontrolled hypertension
Pregnancy (when used for hyperprolactinemia indications) — discontinue as soon as pregnancy is confirmed
Postpartum women with a history of coronary artery disease or other severe cardiovascular conditions
Not recommended for prevention of physiologic postpartum lactation due to risk of serious cardiovascular events

Strong CYP3A4 inhibitors (azole antifungals, HIV protease inhibitors): may increase bromocriptine plasma levels
Macrolide antibiotics (e.g., erythromycin): substantially increased bromocriptine plasma levels (reported ~3.7–4.6 fold)
Octreotide: increases bromocriptine AUC
Other ergot alkaloids: concomitant use not recommended due to additive ergot-related toxicity
Dopamine antagonists (phenothiazines, butyrophenones such as haloperidol, metoclopramide): may decrease bromocriptine efficacy
Alcohol: may potentiate adverse effects and reduce tolerability
Antihypertensive agents: additive blood pressure–lowering effect, risk of orthostatic hypotension

Nausea, headache, dizziness, fatigue (common across indications)
Orthostatic hypotension, especially early in treatment
Abnormal involuntary movements (dyskinesia), hallucinations, confusion, and 'on-off' phenomena when used in Parkinson's disease
Somnolence and reported sudden sleep onset during activities, particularly in Parkinson's disease patients
Psychiatric effects: psychomotor agitation, psychotic disorders, impulse control disorders (pathological gambling, hypersexuality, compulsive spending)
Ergot-related fibrotic complications with long-term/high-dose use: pleural and pericardial effusion/fibrosis, constrictive pericarditis, retroperitoneal fibrosis, cardiac valvulopathy
Digital vasospasm/exacerbation of Raynaud's phenomenon
Postpartum use associated with rare but serious seizures, stroke, and myocardial infarction, often preceded by severe headache and visual disturbances
Increased risk of melanoma reported in Parkinson's disease populations (etiology unclear, not specific to bromocriptine)

Blood pressure, particularly during the first days to weeks of therapy and in the postpartum setting
Prompt discontinuation and evaluation for severe headache, visual disturbance, hypertension, or signs of CNS toxicity
Visual field examination in patients with macroprolactinoma (risk of tumor changes)
Growth hormone/IGF-1 levels in acromegaly to guide dosing
Periodic hepatic and renal function tests
Screening for impulse control disorders and neuropsychiatric symptoms
Periodic evaluation for signs of fibrosis (pulmonary, cardiac, retroperitoneal) with prolonged/high-dose use; consider echocardiography if valvulopathy suspected
Routine dermatologic skin examinations

Pregnancy: For hyperprolactinemia indications, bromocriptine should be discontinued as soon as pregnancy is confirmed; large cohort data did not show an increased rate of birth defects above background population risk, but ongoing use requires individualized risk-benefit assessment
Lactation: Contraindicated for use in postpartum women to suppress physiologic lactation due to risk of serious cardiovascular adverse events (hypertension, seizures, stroke, myocardial infarction)