The safety of bromocriptine in long-term use: a review of the literature

Weil, Claude

doi:10.1185/03007998609111089

Cited by 43 publications

(16 citation statements)

References 112 publications

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“…Others authors did not report obstetric or neonatal morbidity in women who used the drug throughout pregnancy [28]. However, although more than 6,000 bromocriptine-induced pregnancies were reported [29], data on the drug use during the whole gestation are limited to just over 100 cases [30].…”

Section: Prolactinomas and Pregnancymentioning

confidence: 98%

Prolactinomas and Pregnancy

Bronstein

2005

Pituitary

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Prolactinomas are the most frequent pituitary tumors. Treatment of infertility in such tumors usually is very successful. On the other hand, reports of pituitary tumor growth during pregnancy have been described since bromocriptine started to be used. Since then, dopamine agonists (DA) have been increasingly used as the first-choice treatment of prolactinomas, with surgery being reserved for resistance or persistent intolerance to DA or for special situations. More recently other DA, such as quinagolide and cabergoline have shown better tolerance than bromocriptine with similar or greater efficacy. Cabergoline is now the first choice drug but its use in pregnancy is still under evaluation. We followed 71 term pregnancies in women bearing microprolactinomas. Of the 22 patients with previous surgery, none presented symptoms of tumor growth. Of the 41 pregnant patients treated with bromocriptine alone, only one (2.4%) presented with headaches, which regressed with drug reintroduction. Fifty one term pregnancies in patients with macroprolactinomas were followed by us. Of those, 21 were in patients with previous surgery and none of them presented clinical evidence of tumor growth. On the other hand, of the 30 patients treated only with pre-gestational bromocriptine, 11 (37%) manifested complaints related to tumor growth. A non-hormonal contraceptive should be the use along with a DA drug until tumor shrinkage within sellar boundaries has been evidenced. After pregnancy has been confirmed, the DA can be withdrawn and the patient must be closely followed. If tumor expansion is suspected, confirmation can be made through MRI and by visual field testing. Reintroduction of bromocriptine in such cases can lead to tumor reduction and clinical improvement. Surgery can also be employed as treatment for symptomatic tumor growth in pregnancy.

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Section: Prolactinomas and Pregnancymentioning

confidence: 98%

Prolactinomas and Pregnancy

Bronstein

2005

Pituitary

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“…Bromocriptine crosses the placenta, and has been shown to lower fetal serum levels of prolactin.£65) However, an analysis of the outcome of more than 2000 pregnancies in which embryos and fetuses of all gestational ages were exposed to bromocriptine, did not reveal an increase in the incidence of congenital anomalies or of spontaneous abortions.£66] In addition, the outcomes of more than 350 children born of mothers receiving bromocriptine during pregnancy, some for more than 30 weeks of continuous exposure, and followed for up to 9 years, confirm the safety of the drug. [66,67] To date, there is no evidence oflong term harmful effects of bromocriptine on hepatic, renal or haematological functions. An exhaustive review of the rare and almost always reversible adverse effects can be found elsewhere.r 66 1…”

Section: Long Term Adverse Effectsmentioning

confidence: 98%

Adverse Effects of Fertility Drugs

Derman

Adashi

1994

Drug Safety

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Ovulation-induction agents are commonly used in the treatment of infertility in patients with or without ovulatory disturbances. These agents include clomifene, bromocriptine, gonadotrophin preparations and gonadotrophin-releasing hormone (GnRH) and its analogues. Each agent is associated with its own specific adverse effects. Although many of these adverse effects are benign and self-limited, some, in particular those effects associated with gonadotrophins, may be life-threatening. Commonly noted adverse effects encountered with the use of pharmacological agents to treat infertility include the following. Clomifene has been associated with hot flushes, multiple gestation, visual disturbances, cervical mucus abnormalities and luteal phase deficiency. Similarly, most of the adverse symptoms associated with bromocriptine are short-lived, such as nausea and postural hypotension. On the other hand, gonadotrophin therapy, even when used appropriately, may lead to the ovarian hyperstimulation syndrome (which is occasionally life-threatening) and a high incidence of multiple gestation. Pulsatile GnRH therapy maybe accompanied by similar adverse effects to those of gonadotrophins, but with a far lower incidence. With regards to the long term safety of these medications, the relationship between fertility drugs and epithelial ovarian cancer is controversial, and causality has yet to be proven. Indeed, a working knowledge of the many adverse effects associated with these medications is essential to any physician prescribing ovulation induction agents, in order to ensure maximum patient safety, compliance and understanding.

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“…In fact, adverse fibrogenic effects from the drug seem more unusual in clinical practice than once suggested, and it has even been claimed that there is no significant overrepresentation of pleural lesions in patients treated with bromocriptine as compared to controls [23]. In addition to the original article by RINNE [2], 16 further reports comprising 30 patients overall have so far been published (table 2).…”

Section: Discussionmentioning

confidence: 98%

Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos

Hillerdal¹,

Lee²,

Blomkvist³

et al. 1997

Eur Respir J

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P Pl le eu ur ra al l d di is se ea as se e d du ur ri in ng g t tr re ea at tm me en nt t w wi it th h b br ro om mo oc cr ri ip pt ti in ne e i in n p pa at ti ie en nt tsFifteen patients with former exposure to asbestos, who developed pleural fibrosis after treatment with bromocriptine, were observed independently in Sweden (11 patients) and Australia (four patients).The patients complained of malaise, often associated with weight loss, dyspnoea, and a disturbing cough. Laboratory values included increased erythrocyte sedimentation rate and a low haemoglobin level. Lung function tests showed a restrictive lung function defect. Chest radiographs showed bilateral pleural fibrosis, with small amounts of fluid in some cases. Soon after bromocriptine was withdrawn, the patients improved clinically, and the laboratory values returned to normal. However, in most cases, pleural fibrosis and a restrictive lung function defect persisted to some extent.In conclusion, in patients who develop pleuropulmonary fibrosis whilst being treated with bromocriptine, former exposure to asbestos should be investigated. Conversely, when pleural changes develop in a patient on bromocriptine and with prior exposure to asbestos, the possible causative role of the drug should be discussed. Special follow-up may be indicated when bromocriptine is planned in a patient with previous asbestos exposure, and if symptoms or signs of pleural fibrosis develop, bromocriptine withdrawal should be considered.

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The safety of bromocriptine in long-term use: a review of the literature

Cited by 43 publications

References 112 publications

Prolactinomas and Pregnancy

Prolactinomas and Pregnancy

Adverse Effects of Fertility Drugs

Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos

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