parlodel
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| Product dosage: 2.5mg | |||
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Synonyms | |||
Parlodel, generically known as bromocriptine mesylate, is a dopamine receptor agonist that has carved out a significant niche in neuroendocrinology and reproductive medicine since its introduction. It’s fascinating how a compound initially investigated for Parkinson’s disease found its true calling in managing hyperprolactinemia and related conditions. The way it mimics dopamine to suppress prolactin secretion from the anterior pituitary represents one of those beautiful accidents in pharmacology.
Parlodel: Dopamine Agonist Therapy for Hyperprolactinemia and Beyond - 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 for conditions involving prolactin dysregulation. What is Parlodel used for? Primarily, it addresses hyperprolactinemia - that persistent elevation of prolactin that wreaks havoc on reproductive function. But its applications extend to Parkinson’s disease management and acromegaly treatment, making it a versatile tool in the neuroendocrine arsenal.
I remember when we first started using Parlodel in the late 80s - the transformation we saw in patients with prolactinomas was nothing short of remarkable. Women who hadn’t menstruated in years suddenly restoring normal cycles, couples achieving pregnancy after years of infertility struggles. The medical applications of Parlodel extend beyond just normalizing lab values - it restores quality of life.
2. Key Components and Bioavailability Parlodel
The composition of Parlodel centers on bromocriptine mesylate, an ergot-derived dopamine D2 receptor agonist. The molecular structure features that ergoline backbone that gives it both its efficacy and some of its side effect profile. The release form has evolved from the original 2.5mg tablets to include capsules in some markets.
Bioavailability of Parlodel is notoriously low - we’re talking about 6-7% oral bioavailability due to extensive first-pass metabolism. This is why we always emphasize taking it with food, though honestly even then the absorption is pretty variable between patients. The half-life is relatively short at 3-4 hours, which is why multiple daily dosing was traditionally necessary, though many patients now benefit from the longer-acting cabergoline.
3. Mechanism of Action Parlodel: Scientific Substantiation
How Parlodel works comes down to its dopamine agonist properties. It directly stimulates dopamine D2 receptors in the anterior pituitary, which inhibits prolactin secretion both basally and in response to various stimuli. The scientific research behind this mechanism is robust - we’re talking about decades of endocrine studies confirming this pathway.
The effects on the body extend beyond just prolactin suppression though. In Parkinson’s disease, it helps restore dopaminergic tone in the nigrostriatal pathway. For acromegaly, it modestly reduces growth hormone secretion, though this effect is less pronounced than with modern somatostatin analogs. The mechanism of action also involves some serotonin receptor antagonism, which contributes to both therapeutic and adverse effects.
4. Indications for Use: What is Parlodel Effective For?
Parlodel for Hyperprolactinemia
This is where Parlodel truly shines. Whether we’re dealing with microprolactinomas, idiopathic hyperprolactinemia, or medication-induced elevation, the indications for use are well-established. I’ve seen prolactin levels normalize in over 80% of patients within 4-8 weeks of initiation.
Parlodel for Infertility Treatment
The restoration of gonadal function is perhaps the most gratifying aspect. For treatment of anovulatory infertility related to hyperprolactinemia, the success rates are impressive. One of my patients, Sarah, 32, had been trying to conceive for 5 years with prolactin levels consistently above 120 ng/mL. Within 3 months of Parlodel therapy, her levels normalized, and she conceived naturally in the fourth month.
Parlodel for Parkinson’s Disease
While not first-line anymore, Parlodel for Parkinson’s disease still has a role, particularly as adjunctive therapy. The benefits in early disease or as a way to reduce levodopa requirements shouldn’t be overlooked.
Parlodel for Acromegaly
For acromegaly treatment, it’s less potent than modern agents but can be useful in mixed growth hormone/prolactin secreting adenomas or when other options aren’t tolerated.
5. Instructions for Use: Dosage and Course of Administration
The instructions for use of Parlodel require careful titration to minimize side effects. We always start low and go slow - that’s the golden rule.
| Indication | Initial Dosage | Maintenance Dosage | Administration |
|---|---|---|---|
| Hyperprolactinemia | 1.25 mg at bedtime | 2.5-7.5 mg daily in divided doses | With food |
| Parkinson’s Disease | 1.25 mg twice daily | 10-40 mg daily in divided doses | With meals |
| Acromegaly | 1.25-2.5 mg at bedtime | 10-20 mg daily in divided doses | With food |
How to take Parlodel effectively involves starting with the 1.25 mg at bedtime for the first 3 days, then increasing gradually. The course of administration typically continues until prolactin normalizes or for 6-12 months in microprolactinomas before considering dose reduction.
6. Contraindications and Drug Interactions Parlodel
The contraindications for Parlodel are significant and non-negotiable. Uncontrolled hypertension, severe ischemic heart disease, and sensitivity to ergot derivatives are absolute contraindications. The side effects profile includes nausea, orthostatic hypotension (especially early in treatment), and rarely but importantly, psychiatric manifestations.
Interactions with other medications are numerous. Combining Parlodel with macrolide antibiotics, azole antifungals, or protease inhibitors can significantly increase bromocriptine levels. The question of is it safe during pregnancy has been extensively studied - we generally discontinue once pregnancy is confirmed in microprolactinomas, though continue in macroprolactinomas to prevent tumor expansion.
7. Clinical Studies and Evidence Base Parlodel
The clinical studies supporting Parlodel span decades. A 1980 New England Journal of Medicine study demonstrated normalization of prolactin in 80% of patients with microprolactinomas. More recent comparative studies, while showing cabergoline’s superiority in tolerability, still confirm Parlodel’s effectiveness.
The scientific evidence from endocrine societies consistently supports dopamine agonists as first-line for prolactinomas. Physician reviews often note that while newer agents are better tolerated, Parlodel’s cost-effectiveness and extensive safety data maintain its relevance, particularly in resource-limited settings.
8. Comparing Parlodel with Similar Products and Choosing a Quality Product
When comparing Parlodel with similar dopamine agonists, cabergoline generally wins on tolerability and dosing convenience. However, the cost difference can be substantial, and for patients who tolerate Parlodel well, it remains an excellent choice. Which Parlodel formulation is better depends on individual patient needs - some prefer the divided dosing for more consistent symptom control.
How to choose between dopamine agonists involves considering side effect profiles, dosing frequency, cost, and specific indications. For pregnancy planning, many endocrinologists still prefer Parlodel due to the more extensive pregnancy safety data compared to newer agents.
9. Frequently Asked Questions (FAQ) about Parlodel
What is the recommended course of Parlodel to achieve results?
Most patients see prolactin normalization within 4-12 weeks, with full restoration of gonadal function potentially taking several months. We typically continue treatment for 12-24 months before considering withdrawal in microprolactinomas.
Can Parlodel be combined with antihypertensive medications?
Yes, but careful monitoring is essential due to potential additive hypotensive effects, particularly during the initial titration phase.
How long does it take for menstrual cycles to resume with Parlodel treatment?
Typically 4-12 weeks after prolactin normalization, though individual variation is significant based on duration of amenorrhea prior to treatment.
Is weight gain a common side effect of Parlodel?
Actually, some patients experience mild weight loss, though significant weight changes aren’t typically characteristic of Parlodel therapy.
10. Conclusion: Validity of Parlodel Use in Clinical Practice
The risk-benefit profile of Parlodel remains favorable for appropriate indications. While newer agents offer advantages in some areas, Parlodel’s extensive safety data, cost-effectiveness, and reliable efficacy maintain its validity in clinical practice. For hyperprolactinemia management, it continues to be a valuable therapeutic option.
I’ll never forget Mrs. G, 68-year-old with a macroprolactinoma who’d failed transsphenoidal surgery back in ‘92. Her prolactin was sitting at 580, vision was compromised, and she was miserable with headaches. We started Parlodel, titrated up slowly over 6 weeks despite the nausea and dizziness she experienced initially. By month 3, her prolactin was down to 45, vision normalized, headaches gone. She stayed on maintenance 5mg daily for 15 years with excellent control.
The development journey wasn’t smooth though - I remember the debates in our department about whether to push for higher doses faster versus the conservative approach. Dr. Williamson was adamant about aggressive dosing while I favored slower titration. We eventually settled on the slow approach after seeing better long-term adherence, though it meant slower symptom resolution.
What surprised me was how variable the response could be - some patients would normalize prolactin on 2.5mg daily while others needed 15mg. We never did figure out the pharmacokinetic reason for that variability. The failed insight was thinking we could predict response based on tumor size - turned out the relationship was much more complex.
Follow-up with these patients over decades has taught me that the initial 6 months are crucial - if they get through the side effects, most do remarkably well long-term. Mr. T, 45 with a mixed GH/prolactin secreting adenoma, has been on Parlodel for 8 years now with maintained normalization of both hormones and no tumor growth on serial MRIs. He still complains about the nausea if he takes it without food, but says it’s worth it for the symptom control.
The longitudinal data really supports the safety - we’ve got patients on this for 20+ years without significant complications. The key is appropriate patient selection and careful monitoring, particularly in the first year. It’s not the newest drug on the block, but sometimes the old tools are the most reliable ones in the box.