Key points
- We recommend to consult your poison centre with the use of this antidote.
- Bromocriptine is contraindicated in the presence of uncontrolled hypertension, preeclampsia and if medical history of angina, infarct or stroke.
- Treatment with bromocriptine does not replace supportive therapy, treatment of neuromuscular paralysis and external cooling in severe cases of neuroleptic malignant syndrome.
- If neuroleptic malignant syndrome rigidity is severe and treatment resistant, the use of dantrolene can also be considered (see Dantrolene).
+ Synonyms and other terms
- Bromocriptine mesylate
- Mésylate de bromocriptine
- Parlodel ®
+ Indications
- Indicated for the treatment of neuroleptic malignant syndrome caused by antipsychotics or withdrawal from dopamine agonists (ex: levodopa).
+ Dosage
+ Pediatric Dose
- 0.08 mg/kg/dose (max 10 mg) PO or NG tube every 6 to 8 h.
+ Adult Dose
- 2.5 - 10 mg PO or NG tube every 6 to 8 h.
+ Renal Impairment
No data suggests that the dose should be modified for short-term use.
+ Hepatic Impairment
No data suggests that the dose should be modified for short-term use.
+ Hemodialysis Patient
No data suggests that the dose should be modified for short-term use.
+ Pregnancy
- The use of bromocriptine during pregnancy is possibly safe
- Do not hesitate to use the bromocriptine during pregnancy if the anticipated toxic effects pose a significant risk of morbidity or mortality.
- No data suggests that the dose should be modified for short-term use.
+ Obese or Overweight Patient
No data suggests that the dose should be modified for short-term use.
+ Adverse effects
It is worth noting that the underlying treated disease, neuroleptic malignant syndrome, can exert similar signs and symptoms that the following bromocriptine adverse effects.
- Nausea is the most frequent adverse effect
- Cardiovascular effects:
- Hypotension and orthostatic hypotension may occur particularly upon initiation and dose escalation.
- CNS effects:
- Hallucinations and agitation.
- Recurrence of psychiatric symptoms previously treated with the neuroleptic may occur.
- Rare severe effects:
- Hypertension, vascular thrombosis, myocardial infarction, stroke and seizure.
- Cases of severe complications (vascular thrombosis, seizure) are mainly associated with early postpartum bromocriptine administration
- Pulmonary infiltrates have been reported with prolonged and high-dose daily use
+ Monitoring
- Vital signs
- Gastrointestinal symptoms
- Neuroleptic malignant symptoms
+ End of treatment
- Response to treatment can take several days.
- When the clinical signs of neuroleptic malignant syndrome are no longer present, patients should be weaned over at least a 3-day period to avoid recurrence of symptoms.
+ Special Notes on Administration
Enteral Route
- PO
- NG tube
- Finely grind tablets with a mortar and pestle just before use or use the content of capsules.
- Dilute the resulting powder in 10 - 30 ml of sterile water for injection and draw up the resulting liquid using an oral syringe.
- Rinse NG tube with 15 - 30 ml of sterile water for injection before administration.
- Administer the antidote through the NG tube.
- Rapidly rinse the NG tube with 15 - 30 ml of sterile water for injection.
+ Available products
+ Amount required to treat a person weighting 70kg during 24 hours
- At least 40 mg.
+ References
Croarkin, Paul E., Graham J. Emslie, and Taryn L. Mayes. 2008. “Neuroleptic Malignant Syndrome Associated with Atypical Antipsychotics in Pediatric Patients: A Review of Published Cases.” The Journal of Clinical Psychiatry 69 (7):1157–65.
Kaufman, Kenneth R., Michael J. Levitt, John F. Schiltz, and Jagadeeshan Sunderram. 2006. “Neuroleptic Malignant Syndrome and Serotonin Syndrome in the Critical Care Setting: Case Analysis.” Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists 18 (3):201–4.
Margetić, Branimir, and Branka Aukst Margetić. 2010. “Neuroleptic Malignant Syndrome and Its Controversies.” Pharmacoepidemiology and Drug Safety 164. https://doi.org/10.1002/pds.1937.
Pileggi, Dominic J., and Aaron M. Cook. 2016. “Neuroleptic Malignant Syndrome.” The Annals of Pharmacotherapy 50 (11):973–81.
Stevens, Debra L. 2008. “Association between Selective Serotonin-Reuptake Inhibitors, Second-Generation Antipsychotics, and Neuroleptic Malignant Syndrome.” The Annals of Pharmacotherapy 42 (9):1290–97.
Ty, Edna B., and A. David Rothner. 2001. “Topical Review : Neuroleptic Malignant Syndrome in Children and Adolescents.” Journal of Child Neurology 16 (3). SAGE Publications Inc:157–63.
AHFS Drug Information 2024, Bromocriptine Mesylate monograph, consulted online STAT!Ref, 2024-02-07
