Bromocriptine

INTRODUCTION

Indications

Adjunct to levodopa in the treatment of parkinsonism. Treatment of hyperprolactinemia (amenorrhea/galactorrhea), including associated female infertility. Treatment of acromegaly. Unlabeled Use: Management of pituitary prolactinomas. Management of neuroleptic malignant syndrome.

Action

Activates dopamine receptors in the CNS. Decreases prolactin secretion. Therapeutic Effects: Relief of rigidity and tremor in parkinsonism. Restoration of fertility in hyperprolactinemia. Decreased growth hormone in acromegaly.

Adverse Reactions/Side Effects

CNS: dizziness, confusion, drowsiness, hallucinations, headache, insomnia, nightmares. EENT: burning eyes, nasal stuffiness, visual disturbances. Resp: effusions, pulmonary infiltrates. CV: MI, hypotension. GI: nausea, abdominal pain, anorexia, dry mouth, metallic taste, vomiting. Derm: urticaria. MS: leg cramps. Misc: digital vasospasm (acromegaly only).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor cardiac symptoms at rest and during exercise. Seek immediate medical assistance if symptoms of MI develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Assess patient's motor function to help determine antiparkinson effects, especially when starting drug therapy, or during dosing changes or addition of other antiparkinson drugs. Motor function should be assessed at different times of the day, such as when drugs are reaching peak therapeutic levels (i.e., 1–2 hr after oral dose), as well as when drug effects are minimal (just before the next dose).

• Document increased side effects such as involuntary movements (dyskinesias) or fluctuations in response (on-off phenomenon, end-of-dose akinesia). Notify physician because increased side effects might require dose adjustment or a change in medication regimen.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor confusion, hallucinations, and other psychologic problems. Repeated or excessive symptoms may require change in dose or medication.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences increased dizziness, syncope, or other symptoms.

• Monitor respiratory function at rest and during exercise. Notify physician if patient experiences signs of pulmonary infiltrates or effusion, including cough, shortness of breath, chest pain, or labored breathing.

• If used to treat acromegaly, periodically assess body weight and other anthropometric measures (body mass index, limb circumferences) to help document whether drug therapy is effective in reducing the effects of increased growth hormone.

• If treating acromegaly, watch for signs of digital vasospasm as indicated by decreased circulation to the fingers and toes resulting in pain, numbness, swelling, and color changes in the affected digits. Report these signs to the physician, and educate patient about how to avoid the onset ...