(FDA approved in bold)

• Parkinson’s disease (PD)
  
• Acromegaly
  
• Hyperprolactinemia

• Dopamine agonist, with high affinity for the D2 receptor. This action is the reason for effectiveness. Also has weak alpha-agonist activity. In the treatment of hormone-secreting pituitary adenomas, bromocriptine works as a dopamine agonist, which inhibits prolactin-secreting cells in the anterior pituitary, reducing tumor size

• PD – weeks

• PD – may require dose adjustments over time or augmentation with other agents. Most PD patients will eventually require levodopa-carbidopa to manage their symptoms

• PD – Bradykinesia, gait and tremor should improve. Non-motor symptoms including autonomic symptoms such as postural hypotension, depression, and bladder dysfunction do not improve. If the patient has significantly impaired functioning, add or replace with levodopa

• For suboptimal effectiveness add carbidopa-levodopa with or without a COMT inhibitor. MAO-B may also be beneficial
  
• For younger patients with bothersome tremor: anticholinergics may help
  
• For severe motor fluctuations and/or dyskinesias with good “on” time, functional neurosurgery (deep brain stimulation) is an option
  
• Depression is common in PD and may respond to low dose SSRIs
  
• Cognitive impairment/dementia is common in mid-late stage PD and may improve with acetylcholinesterase inhibitors
  
• For patients with late-stage PD experiencing hallucinations or delusions, withdraw bromocriptine and consider oral atypical neuroleptics (quetiapine, olanzapine, clozapine). Acute psychosis is a medical emergency that may require hospitalization for stabilization

• None required