Possible Cocaine Predisposition to Adverse Cerebrovascular and Cardiovascular Sequelae of Bromocriptine Administered Postpartum

Miller, Lucinda G.; Bakht, Fred R.; Baker, Tahirih; Kirshon, Brian

doi:10.1002/j.1552-4604.1989.tb03419.x

Cited by 9 publications

(7 citation statements)

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“…A total of 45 cases of ischaemic disorders attributed to bromocriptine use in lactation inhibition have already been published, including six fatal cases. They consisted of myocardial infarction, [14][15][16][17][18][19][20][21][22][23][24][25] haemorrhagic stroke, [26][27][28][29][30] ischaemic stroke, [31][32][33] postpartum cerebral angiopathy, [34][35][36][37][38][39][40][41][42][43] and peripheral ischaemia. 25,44,45 After pooling data from our survey and the literature, 92 patients experienced a serious ischaemic cardiovascular ADR, 47 of whom (51%) had a predisposing cardiovascular factor (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey

Bernard

Jantzem

Becker³

et al. 2015

BJOG

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Objective To assess the nature and conditions of the occurrence of adverse drug reactions (ADRs) of bromocriptine, which is used to inhibit lactation.Design Observational study.Setting Cases from the French pharmacovigilance database and the marketing authorisation holders.Sample Serious ADRs reported between 1994 and 2010 in association with bromocriptine used for lactation inhibition in France.Methods Each case was checked to confirm the bromocriptine indication, the seriousness of the ADR, the modalities of bromocriptine use, and to identify possible associated predisposing factors.Main outcome measures Number and description of serious ADRs, with a particular focus on misuse and associated predisposing factors.Results Among 105 serious ADRs, including two fatal cases, the most frequent were cardiovascular (70.5%), neurological (14.3%), and psychiatric (8.6%) disorders. Cardiovascular disorders primarily consisted of ischaemic manifestations (n = 47): acute ischaemic stroke (n = 18, one death), myocardial infarction (n = 11, one death), and reversible postpartum cerebral angiopathy (n = 10). Misuse was identified in 52 cases (70.3%) of cardiovascular disorders, and mostly consisted of bromocriptine continuation despite the occurrence of first symptoms suggesting an ADR or the absence of a progressive titration of bromocriptine. About half of these women had cardiovascular predisposing factors, mainly tobacco smoking, overweight or obesity, or a history of hypertension or preeclampsia.Conclusions This survey, together with published data, provides further evidence that serious ADRs still occur after bromocriptine use in lactation inhibition, and that most of these ADRs could have been avoided. The use of bromocriptine should therefore be limited to cases where no other options are available to inhibit lactation.

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Section: Discussionmentioning

confidence: 99%

Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey

Bernard

Jantzem

Becker³

et al. 2015

BJOG

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“…The available medical literature on pregnancy-related pulmonary edema can be divided into four primary realms. (a) The majority of articles focus on pulmonary edema in association with tocolytic therapy, reporting an incidence of 0-5% (Bakhat, Kirshon, Baker, & Cotton, 1990;Cunningham, Lucas, & Hankins, 1987;Ingemarsson, Arulkumaran, & Kottegoda, 1985;Lavies & Turner, 1989;Lipshitz, 1981;Milos et al, 1988;Philipsen, Erikson, & Lynggard, 1981;Pisani & Rosenow, 1989;Wagner, Motor, Johnson, O'Grady, & Speroff, 1981;Watson & Morgan, 1989;Yost & Michalowski, 1990). These articles are inclined to debate whether tocolytic-induced pulmonary edema is cardiogenic or noncardiogenic in origin (Bier et al, 1988;Blickstein, Zalel, Katz, & Lancet, 1988;Gupta, Romano, & Thomas, 1989;Ogburn, Julian, Williams, & Thompson, 1986;Pisani & Rosenow, 1989;Watson & Morgan, 1989).…”

Section: Literature Reviewmentioning

confidence: 99%

“…Although the literature includes various explanations for the pathogenesis of pulmonary edema in pregnancy due to beta-mimetic tocolytic therapy, it is generally accepted that this adverse reaction is unique to pregnancy (Gupta et al, 1989;Ingemarsson et al, 1985;Milos et al, 1988;Pisani & Rosenow, 1989;Watson & Morgan, 1989). For instance, higher doses of beta-mimetics have been used successfully to treat asthmatic patients without the development of pulmonary edema (Ingemarsson et al, 1985;Pisani & Rosenow, 1989).…”

Section: Beta-mimetic Tocolytic Therapymentioning

confidence: 99%

“…This pregnancy-specific reaction may occur because beta-mimetics are known to stimulate further the renin-angiotensin-aldosterone system during gestation (Ingemarsson et al, 1985;Philipsen et al, 1981). The additional renin-angiotensin-aldosterone system activity incited by the beta-mimetic therapy can result in superfluous reabsorption of water and sodium from the renal tubules (Milos et al, 1988) and contribute to fluid volume overload (Pisani & Rosenow, 1989).…”

Section: Beta-mimetic Tocolytic Therapymentioning

confidence: 99%

“…In normal cardiovascular and respiratory changes in pregnancy, blood volume increases by approximately 45% (Cunningham, MacDonald, & Gant, 1989;Gilbert & Harmon, 1986), partially because of plasma volume expansion from approximately 2.5 to 3.7 L (Milos, Aberle, Parkinson, Batra, & Brown, 1988). This escalation in volume is magnified in multiple gestations (Pisani & Rosenow, 1989).…”

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Pulmonary Edema in Pregnancy

Witry

1992

Journal of Obstetric, Gynecologic & Neonatal Nursing

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Recurrent myocardial infarction in a postpartum patient receiving bromocriptine

Eickman

1992

Clinical Cardiology

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Summary:Myocardial infarction in puerperium is infrequently reported. Spasm, coronary dissection, or atheromatous etiology has been described. Bromocriptine has been implicated in several previous case reports of myocardial infarction in the puerperium. Our case (including an inadvertent rechallenge) suggests such a relationship. Although generally regarded as "safe," possible serious cardiac effects of bromocriptine should be acknowledged.Key words: myocardial infarction, bromocriptine, puerperium been reported infrequently. In a recent review, 21 cases of postpartum coronary artery dissection have been reported, 6 were diagnosed antem~rtem.~The possibility of coronary spasm as an alternative cause has been entertained. Bromocriptine usage has been implicated as a cause of possible spasm-induced coronary events in the puerperi~m.~.~We report a case of myocardial infarction in the puerperium with normal coronary vessels. Bromocriptine, begun five days prior to infarction, was inadvertently continued and recurrent ischemia developed. Case Report IntroductionMyocardial infarction in pregnancy and puerperium is rare. During pregnancy, coronary atheroma have been associated in over half the cases. ' In contrast, in the puerperium, previous recent review has revealed a paucity of coronary atherosclerotic narrowing. Postpartum myocardial infarctions were often felt associated with young women during their first pregnancy and frequently associated with preeclampsia-eclampsia syndrome.2 Spontaneous coronary artery dissection has A 36-year-old physician presented with prolonged constrictive chest pain and bilateral arm discomfort. When first observed in the emergency room, inferior lateral STsegment elevation was noted. Symptoms and ST elevations resolved without therapy. Aspirin and heparin were given and urgent catheterization was recommended.Past medical history was significant for a C-section done seven days prior to infarction and bromocriptine therapy (for suppression of lactation) for five days prior to infarction. She was on no other medications. There was no history of migraine headaches or hypertension. Catheterization on admission revealed normal coronary vessels with minimal posterior hypokinesis on left ventriculography. Ergonovine maleate was given (total dose 0.20 mg). There was no evidence of spasm focally or diffusely. Peak creatine phosphokinase (CPK) was 982. ECGs evolved inferior lateral T-wave changes. She was discharged on sustained release nifedipine 30 mg and inadvertently continued on bromocriptine 2.5 mg twice daily.Six days after the original admission, she presented with recurrent substernal and bilateral arm discomfort. The discomfort initially was improved with sublingual nitroglycerin but subsequently recurred, prompting emergency room

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Possible Cocaine Predisposition to Adverse Cerebrovascular and Cardiovascular Sequelae of Bromocriptine Administered Postpartum

Cited by 9 publications

References 25 publications

Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey

Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey

Pulmonary Edema in Pregnancy

Recurrent myocardial infarction in a postpartum patient receiving bromocriptine

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