Parlodel: Effective Dopamine Agonist Therapy for Hyperprolactinemia
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Synonyms | |||
Parlodel (bromocriptine mesylate) is a dopamine receptor agonist specifically formulated to address hyperprolactinemic disorders by inhibiting prolactin secretion from the pituitary gland. This medication represents a cornerstone in endocrine therapy, offering targeted action with established clinical efficacy. Its mechanism directly addresses the underlying hormonal imbalance, providing both symptomatic relief and physiological correction for patients with prolactin-secreting adenomas and related conditions. With decades of clinical use and extensive research supporting its profile, Parlodel remains a first-line treatment option endorsed by endocrinology guidelines worldwide.
Features
- Active ingredient: Bromocriptine mesylate
- Available in 2.5mg tablets and 5mg capsules
- Dopamine D2 receptor agonist with high specificity
- Rapid absorption with peak plasma concentrations within 1-3 hours
- Extensive hepatic metabolism via cytochrome P450 system
- Elimination half-life of approximately 15 hours
- FDA-approved since 1978 with extensive post-marketing surveillance data
Benefits
- Effectively reduces elevated prolactin levels to within normal physiological range
- Restores normal gonadal function and fertility in both male and female patients
- Significantly reduces tumor size in prolactin-secreting pituitary adenomas
- Alleviates galactorrhea and associated breast discomfort
- Normalizes menstrual cycles and ovulation in women with hyperprolactinemia
- Improves libido and sexual function in affected patients
Common use
Parlodel is primarily indicated for the treatment of hyperprolactinemia associated with pituitary adenomas (prolactinomas) or idiopathic hyperprolactinemia. It is prescribed for the management of amenorrhea/galactorrhea infertility syndrome, acromegaly as adjunctive therapy, and Parkinson’s disease. The medication is also used off-label for neuroleptic malignant syndrome and type 2 diabetes management. Clinical endocrinologists typically initiate therapy after confirming hyperprolactinemia through serial prolactin measurements and pituitary imaging when indicated.
Dosage and direction
For hyperprolactinemia: Initial dose is 1.25-2.5mg daily, preferably with food to minimize gastrointestinal side effects. Dosage should be gradually increased by 2.5mg increments at 3-7 day intervals until optimal therapeutic response is achieved. Maintenance doses typically range from 2.5mg to 15mg daily divided into two or three administrations. For large macroadenomas, higher doses up to 30mg daily may be required under strict medical supervision. Patients should be instructed to take Parlodel at the same time(s) each day to maintain stable plasma concentrations.
Precautions
Patients should undergo comprehensive ophthalmological examination before initiation and periodically during therapy due to potential retroperitoneal fibrosis. Hepatic and renal function should be monitored regularly, particularly in patients with pre-existing impairment. Caution is advised when administering to patients with history of psychiatric disorders, cardiovascular disease, or Raynaud’s phenomenon. Sudden sleep onset during activities of daily living has been reported, requiring careful patient education about this potential risk. Blood pressure monitoring is essential, especially during dose titration phases.
Contraindications
Parlodel is contraindicated in patients with hypersensitivity to ergot alkaloids, uncontrolled hypertension, toxemia of pregnancy, or coronary artery disease. It should not be used in patients with a history of cardiac valvular disorders or fibrotic syndromes. Concomitant use with macrolide antibiotics, azole antifungals, or protease inhibitors that inhibit CYP3A4 is contraindicated due to potential for serious adverse reactions. The medication is contraindicated in women who are breastfeeding unless specifically indicated for suppression of lactation.
Possible side effect
Common adverse reactions (>10%) include nausea, headache, dizziness, fatigue, and orthostatic hypotension. Gastrointestinal disturbances such as vomiting, abdominal cramps, and constipation affect approximately 30% of patients initially but often diminish with continued therapy. Less frequent side effects (1-10%) comprise nasal congestion, digital vasospasm, and sleep disturbances. Serious but rare adverse events (<1%) include psychiatric manifestations (hallucinations, confusion), cerebrospinal fluid rhinorrhea, pleural effusion, and cardiac valvulopathy. Most side effects are dose-dependent and reversible upon dosage reduction or discontinuation.
Drug interaction
Parlodel demonstrates significant interactions with CYP3A4 inhibitors (ketoconazole, erythromycin) which may increase bromocriptine concentrations and toxicity. Concomitant use with dopamine antagonists (phenothiazines, butyrophenones, metoclopramide) may diminish therapeutic efficacy. Hypotensive agents may potentiate orthostatic hypotension, requiring careful blood pressure monitoring. Ergot alkaloids and other dopamine agonists should not be co-administered due to additive effects. Alcohol may enhance the sedative properties of bromocriptine. Serotonin agonists and SSRIs may increase the risk of serotonin syndrome when combined with Parlodel.
Missed dose
If a dose is missed, patients should take it as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling of doses is not recommended due to increased risk of adverse effects. Patients should contact their healthcare provider if multiple doses are missed or if uncertainty exists about how to resume therapy. Consistent dosing is crucial for maintaining prolactin suppression, particularly in patients being treated for fertility indications.
Overdose
Symptoms of acute overdose may include severe nausea, vomiting, hypotension, confusion, hallucinations, and profound hypotension. Management consists of immediate gastric lavage if ingestion occurred within recent hours, followed by activated charcoal administration. Supportive measures include maintaining adequate hydration, controlling hypotension with intravenous fluids, and monitoring cardiovascular status. There is no specific antidote for bromocriptine overdose. Hemodialysis is not effective due to extensive protein binding and large volume of distribution. Symptomatic and supportive care should be provided in an intensive care setting for severe cases.
Storage
Parlodel tablets and capsules should be stored at controlled room temperature (20-25°C/68-77°F) in their original container, protected from light and moisture. The medication should be kept out of reach of children and pets. Do not store in bathroom areas where humidity fluctuations may occur. Discard any medication that has expired or shows signs of physical deterioration. Unused medication should be properly disposed of according to local regulations, not flushed down toilets or drains.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Parlodel is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual patient responses may vary, and treatment decisions should be based on comprehensive medical evaluation. Patients should consult their healthcare provider for personalized medical advice and report any adverse reactions promptly. The full prescribing information contains complete details regarding indications, contraindications, warnings, and precautions.
Reviews
Clinical studies demonstrate Parlodel’s efficacy in normalizing prolactin levels in 80-90% of patients with microprolactinomas and 60-70% with macroprolactinomas. Long-term follow-up studies show sustained efficacy with maintenance of normal prolactin levels in approximately 85% of patients after 5 years of therapy. Patient-reported outcomes indicate significant improvement in quality of life measures, particularly regarding restoration of fertility and resolution of galactorrhea. Endocrinologists consistently rate Parlodel as a first-line therapy for hyperprolactinemia due to its established safety profile and predictable response characteristics across diverse patient populations.