Poondy Gopalratnam Raman*
Received:June 27, 2019 Published: July 09, 2019
Corresponding author:Poondy Gopalratnam Raman, MGM Medical College, India
Bromocriptine is used in treatment of diabetes mellitus. It acts by increasing dopaminergic activity in hypothalamus and lowers HbA1c by 0.6 to 0.9%. It is not to be used in type 1 diabetes and DKA.
Keywords:Bromocriptine; Hypothalamus; Contra indicators; Infarction; Combination therapy; Quick release bromocriptine
Bromocriptine mesylate is a new modality of treatment for type-2 diabetes. The drug increases dopaminergic activity in the hypothalamus. It lowers HbA1c by 0.6 to 0.9% compared to placebo when added to other oral anti-diabetic agents. It regulates metabolic rhythm. The drug increases insulin sensitivity . There is 24% increase in insulin mediated glucose disposal. Reduces fasting and post prandial hyper insulinemia by 30-70%. Body fat stores and insulin action are controlled by temporal interactions of circadian neuro-endocrine oscillations. Bromocriptine modulates neurotransmeter action in the brain and has been shown to improve glucose tolerance and insulin resistance in obesity and diabetes. Bromocriptine improves glycemic control and glucose tolerance in obese type-2 DM. Both fasting and post prandial blood glucose are reduced. This is due to enhanced maximally stimulated insulin mediated glucose disposal . No change in body weight or BMI occurred with this therapy. Mechanism of Action is unclear. It resets the circadian rhythm at hypothalamic level [3,4]. Preclinical data suggest that decreased hypothalamic dopaminergic tone may be involved in the pathogenesis of insulin resistance. The normal circadian cycle that results in a leaner body in the summer and heavier body in winter is disrupted in humans because of abundant caloric intake year-round resulting in the absence of a lean phase. Stimulation of the hypothalamus promotes the release of several hormones that respond to the traditional shift in caloric intake and storage. Quick-release bromocriptine (D2 against), given once in the morning, stimulates the hypothalamus to release cortisol, growth hormone, and prolactin, allowing a reset of the circadian clock permanently stuck in a winter rhythm. This means there occurs resetting of abnormally elevated hypothalamic drive for increased plasma glucose, triglyceride and free fatty acid levels in fasting and postprandial states in insulin-resistant patients. Other mechanisms, including α-1 antagonist, α-2 agonist, and serotonin and prolactin modulator, may also help to explain bromocriptine’s glucose-lowering effects (Table 1). Bromocriptine quick release (Cycloset) was added on to various antidiabetic agents and studied for 52 weeks safety trial and was found to be useful as add on therapy .
To be given within 2 hours are waking with food. Starting dose is 0.8 mg. Recommended dose is 1.6 to 4.8 mg.
Can cause nausea. Taking with food minimise nausea. Can produce hypotension, somnolence, headache, fatigue, vomiting, diarrhea, constipation and dizziness. Loss of consciousness during migraine may reflect dopamine receptor hypersensitivity [5,6].
a. Hypersensitivity to Ergot
b. Syncope is potentiated
c. Inhibits lactation, hence, not to be given in lactating mothers
d. Type-I DM or diabetic ketoacidosis
e. Not to be given during pregnancy
f. Syncopal migraine
Interact with dopamine receptor antagonist, clozapine, olanzapine and reduces the effectiveness. Increases serum levels of Salycilates, Sulfonamide, Chloramphenicol and Probenecid due to its high protein binding character. Avoid using concomitantly with other Dopamine antagonist such as neuroleptics. They diminish the effectiveness of Bromocriptine.
Store at 25°C and protect from light and moisture.
Bromocriptine mesylate is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type-2 diabetes mellitus. It may be used as monotherapy or as adjunctive therapy to metformin/sulfonylurea. It should not be used to treat type-1 diabetes or diabetic ketoacidosis.
Bio chemistryUniversity of Texas Medical Branch, USA
Department of Criminal JusticeLiberty University, USA
Department of PsychiatryUniversity of Kentucky, USA
Department of MedicineGally International Biomedical Research & Consulting LLC, USA
Department of Urbanisation and AgriculturalMontreal university, USA
Oral & Maxillofacial PathologyNew York University, USA
Gastroenterology and HepatologyUniversity of Alabama, UK
Department of MedicineUniversities of Bradford, UK
OncologyCirculogene Theranostics, England
Radiation ChemistryNational University of Mexico, USA
Analytical ChemistryWentworth Institute of Technology, USA
Minimally Invasive SurgeryMercer University school of Medicine, USA
Pediatric DentistryUniversity of Athens , Greece
The annual scholar awards from Lupine Publishers honor a selected number Read More...
We know the financial complexity of Individual read more...
The annual scholar awards from Lupine Publishers honor a selected number read more...