Oral prednisolone supplement abolishes the acute adverse effects following initiation of depot bromocriptine therapy.

Journal article

OBJECTIVE: Although an effective treatment for hyper-prolactinaemia, initiation of bromocriptine therapy may be associated with significant acute side-effects in some patients, particularly nausea, vomiting and postural hypotension. These may be minimized by initial treatment with i.m. depot bromocriptine (Parlodel-LAR, Sandoz, Basel, Switzerland), but adverse effects following the first injection may still be a significant problem. Following the observation that cortisol deficient patients were subject to an increased incidence of severe side-effects on initiation of bromocriptine therapy, we have evaluated whether concurrent administration of oral prednisolone to patients without cortisol deficiency might reduce adverse effects. DESIGN: Double-blind placebo-controlled trial with prednisolone (20 mg) prior to, and 16 hours after, depot injection of i.m. bromocriptine (50 or 100 mg). PATIENTS: Twenty-one consecutive patients with hyperprolactinaemia (serum prolactin > 1000 mU/l on 3 separate occasions) who were due to start depot bromocriptine and who had a normal cortisol response to insulin-induced hypoglycaemia. MEASUREMENTS: Symptoms at 0, 16 and 40 hours after injection were assessed using visual linear analogue scales and both inter and intra-group scores were compared by non-parametric tests. RESULTS: Depot bromocriptine was associated with the significant occurrence of light-headedness and lethargy in the placebo-administered group by 16 hours, and also with nausea and nasal congestion by 40 hours. These symptoms did not occur in the prednisolone-administered group. CONCLUSIONS: Concurrent oral administration of prednisolone significantly reduces the incidence of acute adverse effects following depot bromocriptine. Two 20 mg doses of prednisolone given at 12-hour intervals may be used to avoid dopamine-agonist-induced adverse effects at the initiation of treatment with depot bromocriptine, and may also be of value in the treatment of side-effects associated with other dopamine agonist drugs.

Authors: Jenkins, P; Jain, A; Jones, S; Besser, G; Grossman, AB

• Publication status: Published
• Journal: Clinical endocrinology
• Volume: 45
• Issue: 4
• Pages: 447-451
• Publication date: 1996-10-01
• DOI: 10.1046/j.1365-2265.1996.8240834.x
• EISSN: 1365-2265
• ISSN: 0300-0664
• Language: English
• Keywords: Bromocriptine; Hypotension; Nausea; Vomiting; Hyperprolactinemia; Administration, Oral; Drug Administration Schedule; Prednisolone; Adult; Middle Aged; Humans; Double-Blind Method; Female; Delayed-Action Preparations; Male