OVERVIEW

PRODUCT INFORMATION

CHEMICAL FORMULA AND STRUCTURE

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DRUG	CAS REGISTRY NUMBER	MOLECULAR FORMULA	STRUCTURE
Bromocriptine	25614-03-3	C32-H40-Br-N5-O5

REFERENCES

References updated: 20 July 2017

• Zimmerman HJ. Antiparkinsonism drugs. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 715-7.

  (Expert review of hepatotoxicity published in 1999; among anticholinergic agents, "only trihexyphenidyl has been incriminated in hepatic injury"; other antiparkinsonism drugs discussed include levodopa, lergotrile [no longer available], pergolide and bromocriptine).
• Larrey D, Ripault MP. Hepatotoxicity of psychotropic drugs and drugs of abuse. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier Inc, 2013, pp. 443-62.

  (Review of hepatotoxicity of agents acting on the central nervous system).
• Standaert DG, Roberson ED. Treatment of central nervous system degenerative disorders. In, Brunton LL, Chabner BA, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill, 2011, pp. 609-28.

  (Textbook of pharmacology and therapeutics).
• McDowell F. Symposium on levodopa in Parkinson's disease. Clinical and pharmacological aspects. Clinical laboratory abnormalities. Clin Pharmacol Ther 1971; 12: 335-9. [PubMed: 4102803]

  (Retrospective analysis of laboratory abnormalities arising in 974 patients with Parkinson disease treated with levodopa; AST elevations occurred in 9% of 5427 determinations, but were usually mild and transient returning to normal in 1-2 months without dose adjustment; AST levels rose to 1600 U/L in one patient who later died of complications of diabetes).
• Calne DB, Plotkin C, Williams AC, Nutt JG, Neophytides A, Teychenne PF. Long-term treatment of parkinsonism with bromocriptine. Lancet 1978; 1: 735-8. [PubMed: 76747]

  (Retrospective analysis of experience in treating 92 patients with Parkinson disease using bromocriptine and levodopa for up to 30 months, serum enzyme elevations occurred in 6 patients [7%] which were transient in 4, required dose modification in 1 and stopping in 1; no clinically apparent liver injury).
• Lieberman AN, Kupersmith M, Gopinathan G, Estey E, Goodgold A, Goldstein M. Bromocriptine in Parkinson disease: further studies. Neurology 1979; 29: 363-9. [PubMed: 571981]

  (Retrospective analysis of experience in treating 66 patients with Parkinson disease using bromocriptine for 2-24 months; mild Alk P elevations occurred in 22% and one patient developed jaundice after 2 months, biopsy showing a toxic hepatitis and stopping leading to recovery; no details given).
• LeWitt PA, Ward CD, Larsen TA, Raphaelson MI, Newman RP, Foster N, Dambrosia JM, et al. Comparison of pergolide and bromocriptine therapy in parkinsonism. Neurology 1983; 33: 1009-14. [PubMed: 6348585]

  (27 patients with Parkinson disease were treated with either pergolide or bromocriptine in a double-blind cross over study and 11 were continued on pergolide for up to one year; the two drugs had comparable effects and side effects, one patient developed mild ALT elevations [59 U/L] that resolved despite continuing bromocriptine).
• Lieberman AN, Gopinathan G, Neophytides A, Goldstein M. Management of levodopa failures: the use of dopamine agonists. Clin Neuropharmacol 1986; 9: S9-21. [PubMed: 3297319]

  (Among 278 patients with Parkinson disease failing to respond to levodopa and treated with a dopamine agonist, 61% improved but adverse events requiring discontinuation occurred in 46%; no discussion of hepatotoxicity).
• Liberato NL, Poli M, Bollati P, Chiofalo F, Filipponi M. Bromocriptine-induced acute hepatitis. Lancet 1992; 340: 969-70. [PubMed: 1357362]

  (82 year old man with Parkinson disease developed ALT elevations [peak value ~730 U/L] within 5 days of starting bromocriptine, resolving within 10 days of stopping and recurring [peak value ~750 U/L] within 5 days of restarting; no mention of symptoms or bilirubin levels).
• Korczyn AD, Brunt ER, Larsen JP, Nagy Z, Poewe WH, Ruggieri S. A 3-year randomized trial of ropinirole and bromocriptine in early Parkinson's disease. The 053 Study Group. Neurology 1999; 53: 364-70. [PubMed: 10430427]

  (In a randomized controlled trial in 35 patients with early Parkinson disease comparing ropinirole to bromocriptine, "no significant laboratory abnormalities" or withdrawals because of liver abnormalities were reported).
• Lambert D, Waters CH. Comparative tolerability of the newer generation antiparkinsonian agents. Drugs Aging 2000; 16: 55-65. [PubMed: 10733264]

  (Review of mechanism of action, tolerability and safety of selegiline, pramipexole, ropinirole, tolcapone and entacapone in Parkinson disease).
• Reuben A, Koch DG, Lee WM; Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology 2010; 52: 2065-76. [PMC free article: PMC3992250] [PubMed: 20949552]

  (Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 were attributed to drug induced liver injury, but none were attributed to agents used for Parkinson disease).
• Björnsson ES, Bergmann OM, Björnsson HK, Kvaran RB, Olafsson S. Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland. Gastroenterology 2013; 144: 1419-25,1425. [PubMed: 23419359]

  (In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, but none of the 96 were attributed to an agent used to treat Parkinson disease).
• Drugs for Parkinson's disease. Treat Guidel Med Lett 2013; 11 (135): 101-6. [PubMed: 24165688]

  (Concise review of recommendations for therapy of Parkinson disease with description of mechanisms of action, efficacy and adverse events).
• Hernández N, Bessone F, Sánchez A, di Pace M, Brahm J, Zapata R, A Chirino R, et al. Profile of idiosyncratic drug induced liver injury in Latin America: an analysis of published reports. Ann Hepatol 2014; 13: 231-9. [PubMed: 24552865]

  (Among 176 reports of drug induced liver injury from Latin America published between 1996 and 2012, none were attributed to an agent to treat Parkinson disease).
• Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al.; United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. Gastroenterology 2015; 148: 1340-52. [PMC free article: PMC4446235] [PubMed: 25754159]

  (Among 899 cases of drug induced liver injury from the US enrolled in a prospective database between 2004 and 2012, none were attributed to an agent used to treat Parkinson disease).