Bromocriptine-associated headache: possible life-threatening sympathomimetic interaction

Article Abstract:

Lactation (milk production in the breasts) is controlled by the hormones estrogen, progesterone and prolactin. During pregnancy, estrogen and progesterone from the placenta prevent the release of milk from the breasts. After birth, when the placenta is removed, prolactin stimulates lactation. Prolactin is made in the brain (pituitary). Lactation can be prevented by a chemical in the brain (neurotransmitter), dopamine, which prevents prolactin from being released by the pituitary. In 1980, a drug called bromocriptine (trade name, Parlodel) was approved by the FDA for preventing lactation, which it does by mimicking the effects of dopamine. However, bromocriptine can cause seizures, high blood pressure, strokes, and heart attacks. In most cases, severe headaches are the first symptom and these usually begin several hours to days before other symptoms. Patients with high blood pressure or those taking medications that increase blood pressure (such as ergot alkaloids) are at risk for having seizures, heart attacks or strokes after taking bromocriptine. Headaches caused by bromocriptine should not be treated with drugs that stimulate the sympathetic nervous system (sympathomimetic drugs), as this can make the symptoms worse. The cases are reported of two women who developed severe headaches after taking bromocriptine. Both patients were given sympathomimetic drugs to treat the headaches, which caused irregular heart beats and seizures. When treatment with bromocriptine was discontinued the symptoms disappeared. It is recommended that treatment with bromocriptine be discontinued if severe headaches develop. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Physiological aspects, Prolactin

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Bromocriptine mesylate for lactation suppression: a risk for postpartum hypertension?

Article Abstract:

Eclampsia is a complication of pregnancy marked by high blood pressure, swelling, protein in the urine, and convulsions. It can occur before, during and 24 hours after delivery, but eclampsia in the postpartum period is rare. High blood pressure occurring 24 hours postpartum may be caused by many factors. Bromocriptine mesylate is a synthetic ergot alkaloid agent used to electively stop the production of breast milk (lactation) after delivery. Although bromocriptine has been known to cause low blood pressure, its ability to raise blood pressure is not known. There have been 50 reports to the Food and Drug Administration (FDA) describing high blood pressure, convulsions, and stroke in postpartum patients who received bromocriptine. This prompted an investigation of the relationship between bromocriptine and the onset of high blood pressure postpartum. Blood pressure was measured in 1,813 women during three postpartum home visits 3 to 21 days after delivery. High blood pressure was defined as 140 millimeters of mercury (mm/Hg) over 90 mm/Hg or greater. Postpartum hypertension was more likely to occur among women of certain races, and women with a history of chronic hypertension, pregnancy-induced hypertension, and antihypertensive medication use. However, the risk of postpartum hypertension was statistically greater among women who experienced pregnancy-induced hypertension and received bromocriptine to inhibit lactation. These findings indicate that bromocriptine should not be given to women with pregnancy-induced high blood pressure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypertension, Causes of, Risk factors, Ergot alkaloids, Puerperal disorders

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Survey of maternal-fetal medicine subspecialists: professional activities, job setting, and satisfaction

Article Abstract:

The subspecialty of obstetrics and gynecology known as maternal-fetal medicine was established in 1972, and in 1986, a survey of 623 of its practitioners was carried out. Members of the Society of Perinatal Obstetricians filled out a questionnaire concerning job satisfaction and professional activities. Results showed an 80 percent return rate, with women physicians making up 16 percent of the respondents. The physicians were university hospital-based (66 percent), community hospital-based (15 percent), in private practice (10 percent), or serving in other professional capacities (9 percent). Different job settings were associated with different proportions of time devoted to clinical work, research, administration, and education. In addition, sources of patients differed, with university hospital-based physicians receiving the majority of their referrals from outside physicians, while physicians in community hospitals tended to receive referrals from other doctors in the same hospital. Respondents had published an average of 6.3 articles in peer-review journals during the previous two years; they had, on average, slightly less than one research grant funded in 1985. Ninety-three percent carried professional liability insurance, and the average number of lawsuits per respondent in his or her career was two. Overall, members of this group appeared active and satisfied with their jobs in all job settings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physicians, Medical professions, Surveys, Vocational guidance, Obstetricians

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