title: Oral prednisolone supplement abolishes the acute adverse effects following initiation of depot bromocriptine therapy.
abstract: OBJECTIVE
  Although an effective treatment for hyper-prolactinaemia, initiation of bromocriptine therapy may be associated with significant acute side-effects in some patients, particularly nausea, vomiting and postural hypotension. These may be minimized by initial treatment with i.m. depot bromocriptine (Parlodel-LAR, Sandoz, Basel, Switzerland), but adverse effects following the first injection may still be a significant problem. Following the observation that cortisol deficient patients were subject to an increased incidence of severe side-effects on initiation of bromocriptine therapy, we have evaluated whether concurrent administration of oral prednisolone to patients without cortisol deficiency might reduce adverse effects.
  
  
  METHODS
  Double-blind placebo-controlled trial with prednisolone (20 mg) prior to, and 16 hours after, depot injection of i.m. bromocriptine (50 or 100 mg).
  
  
  METHODS
  Twenty-one consecutive patients with hyperprolactinaemia (serum prolactin > 1000 mU/l on 3 separate occasions) who were due to start depot bromocriptine and who had a normal cortisol response to insulin-induced hypoglycaemia.
  
  
  METHODS
  Symptoms at 0, 16 and 40 hours after injection were assessed using visual linear analogue scales and both inter and intra-group scores were compared by non-parametric tests.
  
  
  RESULTS
  Depot bromocriptine was associated with the significant occurrence of light-headedness and lethargy in the placebo-administered group by 16 hours, and also with nausea and nasal congestion by 40 hours. These symptoms did not occur in the prednisolone-administered group.
  
  
  CONCLUSIONS
  Concurrent oral administration of prednisolone significantly reduces the incidence of acute adverse effects following depot bromocriptine. Two 20 mg doses of prednisolone given at 12-hour intervals may be used to avoid dopamine-agonist-induced adverse effects at the initiation of treatment with depot bromocriptine, and may also be of value in the treatment of side-effects associated with other dopamine agonist drugs.
authors.affiliation: Department of Endocrinology, St Bartholomew's Hospital, London, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Jenkins
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.forename: S L
authors.initials: SL
authors.lastname: Jones
authors.forename: G M
authors.initials: GM
authors.lastname: Besser
authors.forename: A B
authors.initials: AB
authors.lastname: Grossman
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001971:Bromocriptine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D003692:Delayed-Action Preparations; D001971:Bromocriptine; D011239:Prednisolone