parlodel
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Synonyms | |||
Parlodel, known generically as bromocriptine, is a dopamine receptor agonist that’s been in clinical use for decades. It’s one of those medications that bridges multiple specialties - endocrinology, neurology, and even reproductive medicine. What’s fascinating is how this compound, derived from ergot alkaloids, manages to exert such specific effects despite its complex pharmacology. I’ve prescribed it for everything from prolactin-secreting pituitary tumors to Parkinson’s disease, and the consistency of response still impresses me after all these years.
Parlodel: Dopamine Agonist Therapy for Hyperprolactinemia and Movement Disorders - Evidence-Based Review
1. Introduction: What is Parlodel? Its Role in Modern Medicine
Parlodel represents one of the first-generation dopamine agonists that revolutionized treatment approaches for several conditions. When we talk about what Parlodel is used for, we’re essentially discussing conditions where dopamine pathway modulation can provide therapeutic benefits. The medical applications of Parlodel span from controlling prolactin secretion to managing motor symptoms in movement disorders.
I remember when I first encountered Parlodel during my endocrinology rotation - we had a patient with a macroprolactinoma who’d failed surgical intervention, and bromocriptine literally saved her from needing radiation therapy. That case taught me that sometimes the older medications, when used correctly, can be just as effective as the newer, more expensive alternatives.
2. Key Components and Bioavailability Parlodel
The composition of Parlodel centers around bromocriptine mesylate, which is a semisynthetic ergot alkaloid derivative. The release form matters significantly here - we have immediate-release tablets (2.5 mg) and the newer quick-release formulation that offers more rapid absorption.
Bioavailability of Parlodel is approximately 28% when administered orally, but here’s the clinical pearl I’ve learned: absorption varies significantly with food. Taking it with meals can reduce bioavailability by up to 60%, which explains why some patients don’t respond as expected until we adjust administration timing. The first-pass metabolism is extensive, primarily hepatic, with cytochrome P450 3A4 doing most of the work.
3. Mechanism of Action Parlodel: Scientific Substantiation
Understanding how Parlodel works requires diving into dopamine receptor pharmacology. Bromocriptine acts primarily as a D2 receptor agonist, with some activity at D1 receptors. The effects on the body are mediated through this dopamine mimicry - in the pituitary, it inhibits prolactin secretion by activating D2 receptors on lactotroph cells.
The scientific research behind Parlodel’s mechanism is quite robust. In Parkinson’s disease, it directly stimulates striatal dopamine receptors, compensating for the dopamine deficiency. What many don’t realize is that the ergot structure gives it some serotonin receptor activity too, which probably contributes to some of the side effects we see clinically.
I had this fascinating case with a neurologist colleague - we were managing a patient with both Parkinson’s and prolactinoma, and the dose-response relationship was completely different for each condition. The Parkinson’s symptoms required much higher doses than the endocrine control, which taught us about tissue-specific receptor sensitivity.
4. Indications for Use: What is Parlodel Effective For?
Parlodel for Hyperprolactinemia
This is where Parlodel really shines. The indications for use in hyperprolactinemia include both micro and macroprolactinomas, as well as idiopathic hyperprolactinemia. The reduction in prolactin levels is often dramatic - I’ve seen levels drop from over 200 ng/mL to normal within weeks.
Parlodel for Parkinson’s Disease
As adjunctive therapy for Parkinson’s, Parlodel helps manage motor fluctuations. The treatment benefit is most noticeable in patients experiencing “wearing-off” phenomena with levodopa.
Parlodel for Acromegaly
While not first-line anymore, Parlodel for acromegaly can be effective in some patients, particularly those with mild disease or who can’t tolerate other therapies.
Parlodel for Prevention of Physiological Lactation
This use has become more controversial over the years, but Parlodel for lactation suppression was once quite common. The safety profile has limited this application recently.
5. Instructions for Use: Dosage and Course of Administration
The instructions for use for Parlodel require careful titration to minimize side effects. Here’s the practical approach I’ve developed over years:
| Indication | Starting Dosage | Maintenance Range | Administration |
|---|---|---|---|
| Hyperprolactinemia | 1.25 mg at bedtime | 2.5-15 mg daily | With food to reduce nausea |
| Parkinson’s Disease | 1.25 mg once daily | 10-40 mg daily | Divided doses with meals |
| Acromegaly | 1.25-2.5 mg at bedtime | 20-30 mg daily | Divided into 2-4 doses |
The course of administration typically begins with low evening doses to help patients sleep through the initial side effects. I always warn patients about the potential for first-dose hypotension and nausea - about 30% of my patients experience some transient symptoms during initiation.
6. Contraindications and Drug Interactions Parlodel
The contraindications for Parlodel are significant and non-negotiable. Patients with uncontrolled hypertension, severe coronary artery disease, or sensitivity to ergot alkaloids should avoid this medication. The safety during pregnancy question comes up frequently - we generally discontinue once pregnancy is confirmed in prolactinoma patients, unless it’s a macroprolactinoma threatening vision.
Interactions with other medications can be problematic. Combining Parlodel with other dopamine antagonists like antipsychotics can reduce efficacy. The most dangerous interaction is with macrolide antibiotics or strong CYP3A4 inhibitors, which can dramatically increase bromocriptine levels.
I learned this the hard way early in my career - had a patient on stable Parlodel dosing who developed severe hypotension after starting erythromycin for pneumonia. We had to hospitalize him briefly until we sorted out the interaction.
7. Clinical Studies and Evidence Base Parlodel
The clinical studies supporting Parlodel span decades. A landmark 1980 New England Journal of Medicine study demonstrated normalization of prolactin levels in 80% of microprolactinoma patients. The scientific evidence for Parkinson’s use comes from multiple randomized trials showing significant improvement in UPDRS scores.
What’s interesting is that the effectiveness in real-world practice often exceeds what the clinical trials suggest - I suspect this is because we’ve learned to titrate more gradually than the study protocols allowed. The physician reviews I’ve collected over years consistently note that patience with dose escalation pays dividends.
8. Comparing Parlodel with Similar Products and Choosing a Quality Product
When comparing Parlodel with similar dopamine agonists, the main competitors are cabergoline and the non-ergot derivatives like pramipexole. Cabergoline has better tolerability but concerns about cardiac valve fibrosis limit long-term use. The question of which dopamine agonist is better really depends on the individual patient’s risk factors and tolerance.
How to choose between them? For young women needing long-term prolactin control, I often start with bromocriptine despite the side effect profile because the cardiac safety data is better than with cabergoline. For Parkinson’s patients, the non-ergot agents often have preference due to better tolerability.
9. Frequently Asked Questions (FAQ) about Parlodel
What is the recommended course of Parlodel to achieve results?
Most patients see prolactin reduction within 2-3 weeks, but full effect for tumor shrinkage takes 3-6 months. We typically continue for at least two years before considering dose reduction.
Can Parlodel be combined with antidepressant medications?
Yes, but monitor for additive hypotensive effects. SSRIs generally don’t interfere with dopamine activity significantly.
How long does Parlodel stay in your system?
The half-life is about 6-8 hours, but clinical effects persist longer due to active metabolites.
Is weight gain common with Parlodel?
Actually, weight loss is more common initially due to nausea, though some patients report increased appetite once stabilized.
10. Conclusion: Validity of Parlodel Use in Clinical Practice
The risk-benefit profile of Parlodel remains favorable for specific indications, particularly hyperprolactinemia. While newer agents exist, the decades of safety data and lower cost maintain Parlodel’s relevance in modern practice.
I had this patient, Sarah, 34-year-old teacher with a 8mm prolactinoma - she’d been trying to conceive for three years. We started her on Parlodel despite the nausea concerns because her insurance wouldn’t cover cabergoline. The first month was rough - she called me twice weekly about the dizziness and nausea. But we persisted, splitting the dose, adjusting timing, and by month three her prolactin normalized. The MRI at six months showed 60% reduction in tumor size. She conceived naturally at month eight and delivered a healthy baby girl.
What surprised me was her follow-up last year - she’s been on maintenance dosing for five years now with sustained control and minimal side effects. She told me the initial discomfort was worth pushing through. These are the cases that remind me why we need to maintain familiarity with these older workhorse medications - they might not be the newest or most fashionable, but they get the job done when used properly. The key is managing expectations upfront and being available to troubleshoot those early side effects.