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Parlodel

Parlodel
Parlodel is a dopamine agonist that is used for treating conditions like Parkinson’s disease, acromegaly (abnormal growth of certain body parts), some menstrual problems and certain conditions caused by too much prolactin in the blood.

Brand: Bromocriptine

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: April 2024
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Parlodel 2.5 mg
240 pills - 2.5 mg
+ 12 free Viagra 100 mg, 7% discount for future orders
$417.69 $1.74 $222.23 Add to cart
180 pills - 2.5 mg
+ 12 free Viagra 100 mg, 7% discount for future orders
$316.82 $1.76 $163.12 Add to cart
120 pills - 2.5 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$213.61 $1.78 $106.35 Add to cart
90 pills - 2.5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$161.93 $1.80 $78.04 Add to cart
60 pills - 2.5 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$121.95 $2.03 $38.03 Add to cart
30 pills - 2.5 mg $79.99 $2.67 No Add to cart
Parlodel 1.25 mg
240 pills - 1.25 mg
+ 12 free Viagra 100 mg, 7% discount for future orders
$415.23 $1.73 $192.21 Add to cart
180 pills - 1.25 mg
+ 12 free Viagra 100 mg, 7% discount for future orders
$313.21 $1.74 $142.37 Add to cart
120 pills - 1.25 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$210.06 $1.75 $93.66 Add to cart
90 pills - 1.25 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$159.35 $1.77 $68.44 Add to cart
60 pills - 1.25 mg
+ 4 free Viagra 100 mg, 3% discount for future orders
$117.95 $1.97 $33.91 Add to cart
30 pills - 1.25 mg $75.93 $2.53 No Add to cart

Product description

Drug title

Parlodel (Bromocriptine)

Pharmacological action

Stimulator of dopamine receptors. Inhibits secretion of prolactin, a hormone of the anterior pituitary lobe, without affecting the normal content of other pituitary hormones. However, Parlodel® is able to decrease the elevated level of STH in patients with acromegaly. This action is due to the stimulation of dopamine receptors.


In the postpartum period, prolactin is necessary for the initiation and maintenance of lactation. During other periods of life, increased prolactin secretion leads to abnormal lactation (galactorrhea) and/or disorders of ovulation and menstrual cycle.


Parlodel, as a specific inhibitor of prolactin secretion, can be used to prevent or suppress physiological lactation, as well as to treat pathological conditions caused by hypersecretion of prolactin. In amenorrhea and/or anovulatory menstrual cycles (accompanied or not accompanied by galactorrhea) Parlodel may be used to restore menstrual cycle and ovulation.


When using Parlodel to inhibit lactation, it is not necessary to restrict fluid intake. In addition, Parlodel® does not interfere with postpartum uterine involution or increase the risk of thromboembolism.


Parlodel® stops the growth or reduces the size of prolactinsecreting pituitary adenomas (prolactinomas).


In patients with acromegaly, in addition to reducing plasma concentrations of STH and prolactin, Parlodel has a favorable effect on clinical manifestations and glucose tolerance.


In Parkinson's disease, characterized by specific dopamine deficiency in the striatum and black nucleus region of the brain, stimulation of dopamine receptors by Parlodel® may restore the neurochemical balance in the basal ganglia.


Patients with Parkinson's disease are usually prescribed bromocriptine at higher doses than those used for endocrinologic indications.


Parlodel reduces tremor, rigidity, slowness of movements and other symptoms of Parkinsonism at all stages of the disease. The efficacy of the drug usually lasts for many years (so far, good results of therapy have been described with treatment durations as long as 8 years).


Parlodel reduces the severity of depression symptoms in parkinsonian patients. This is due to its intrinsic antidepressant properties, which have been confirmed in controlled trials in patients with endogenous or psychogenic depression who do not suffer from parkinsonism.


Prolactinizing effect starts 1-2 hours after oral administration, reaches its maximum (decrease of prolactin concentration by more than 80%) in 5-10 hours and maintains at a level close to the maximum level for 8-12 hours.

Pharmacokinetics

Absorption


After oral administration, bromocriptine is well absorbed from the gastrointestinal tract. In healthy volunteers after oral administration of Parlodel in tablet form, the half-absorption period of bromocriptine is 0.2-0.5 hours, Cmax is reached within 1-3 hours. When bromocriptine is taken orally at a dose of 5 mg, Cmax is 0.465 ng/ml.


Distribution


Binding to plasma proteins is 96%.


Metabolism


Bromocriptine undergoes intensive metabolism during "first passage" through the liver to form a number of metabolites. In urine and feces unchanged bromocriptine is practically absent. Bromocriptine has high affinity to CYP3A. The main metabolic pathway is hydroxylation of the proline ring within the cyclopeptide.


Bromocriptine is a strong inhibitor of CYP3A4 with a calculated IC value of 50 1.69 μmol. However, due to the low therapeutic blood concentrations of free bromocriptine, no significant changes are expected in the metabolism of concomitantly used drugs whose clearance is mediated by CYP3A4.


Excretion


The plasma excretion of unchanged bromocriptine is biphasic, with a final T1/2 of approximately 15 h (8 to 20 h). Bromocriptine and its metabolites are almost completely eliminated through the liver, only 6% of the dose is excreted by the kidneys.


Pharmacokinetics in special clinical cases


In patients with hepatic dysfunction, the excretion rate of bromocriptine may decrease and plasma levels may increase, requiring a dosing regimen adjustment.


Concomitant use of inhibitors and/or potential CYP3A4 substrates may decrease bromocriptine clearance and increase its plasma concentrations.


Contraindications to use

  • Uncontrolled arterial hypertension;
  • Gestosis (including eclampsia, preeclampsia);
  • Arterial hypertension during pregnancy and in the postpartum period;
  • CHD and other severe cardiovascular diseases;
  • Severe psychiatric disorders, current and/or past history;
  • children under 7 years of age (experience with this drug is limited);
  • Hypersensitivity to the components of the drug;
  • hypersensitivity to ergot alkaloids.

It is not recommended for the treatment of premenstrual syndrome and benign breast disease due to limited clinical data. 

Use during pregnancy and lactation

After confirmation of the planned pregnancy, Parlodel, as well as other medicines, should be cancelled except in cases of necessity of continuation of therapy for medical indications. Cancellation of Parlodel in pregnancy has not led to an increase in the incidence of spontaneous abortion. Clinical experience shows that the use of Parlodelol in pregnancy has no adverse effect on its course or outcome. When Parlodelol is withdrawn in pregnant women with pituitary adenoma, patients should be closely monitored throughout the pregnancy. If there are signs of a marked increase in prolactinoma, such as headaches or narrowing of the visual fields, treatment with Parlodel may be resumed or surgical intervention may be performed.


During lactation, Parlodel is used when indicated. The drug suppresses lactation, so it is not prescribed to nursing mothers.


Treatment with Parlodel may restore fertility. Therefore, women of childbearing age who do not wish to become pregnant should use a reliable method of contraception.


Use in patients with liver dysfunction

The drug is contraindicated in patients with portal hypertension (including cirrhosis).

Application in children

Contraindication: children under 7 years of age (experience of drug administration is limited).


Efficacy and safety of Parlodel administration have been established in children over 7 years old and in adolescents with prolactinoma and acromegaly. The tolerability of the drug in adults and children was similar in clinical trials and in physician practice. Difficult-to-predict sensitivity to the drug in this category of patients should be taken into account.


Use in elderly patients

In clinical trials, the number of patients aged 65 years and older was insufficient to conduct a comparative evaluation of the effectiveness of Parlodel treatment in younger patients. However, in clinical trials and physician practice, the tolerability of the drug in patients over 65 years of age and younger patients was similar. The difficult to predict tolerability of the drug in this category of patients should be taken into account.

Indications of the drug Parlodel

Menstrual cycle disorders, female infertility


Prolactin-dependent diseases and conditions with or without hyperprolactinemia:


  • Amenorrhea (accompanied and not accompanied by galactorrhea), oligomenorrhea;
  • Luteal phase insufficiency;
  • Secondary hyperprolactinemia caused by medications (e.g. some psychotropic or antihypertensive drugs).

Prolactin-independent female infertility:


  • Polycystic ovarian syndrome;
  • Anovulatory cycles (in addition to anti-estrogens such as clomiphene).

Hyperprolactinemia in men


  • Prolactin-dependent hypogonadism (oligospermia, loss of libido, impotence).

Prolactinomas


  • Conservative treatment of prolactin-secreting micro- and macroadenomas of the pituitary gland;
  • Preoperative preparation to reduce the volume of the tumor and facilitate its removal;
  • postoperative treatment if prolactin levels remain elevated.

Acromegaly

  • As an adjunctive treatment or, in special cases, as an alternative to surgery or radiation treatment.

Lactation Suppression.


  • Prevention or cessation of postpartum lactation for medical reasons, including the initial stages of postpartum mastitis;
  • Prevention of lactation after an abortion.

Parkinson's disease


  • All stages of idiopathic Parkinson's disease and post-encephalitic parkinsonism - either as monotherapy or in combination with other anti-Parkinsonian agents.


Dosing regimen

Parlodel is taken orally with meals.


Menstrual cycle disorders, female infertility


It is prescribed as 1.25 mg (1/2 tablet) 2-3 times per day; if therapeutic effect is not enough, the dose is gradually increased up to 5-7.5 mg per day (number of times 2-3 times per day).


Treatment is continued until normalization of the menstrual cycle and/or restoration of ovulation.


If necessary, treatment may be continued for several cycles to prevent recurrences.


Hyperprolactinemia in men


It is prescribed 1.25 mg (1/2 tablet) 2-3 times per day, gradually increasing the dose to 5-10 mg (2-4 tablets) per day.


Prolactinomas


It is indicated by 1.25 mg (1/2 tablet) 2-3 times per day with gradual dose increase and selection of the dose, which provides adequate decrease of prolactin concentration in plasma.


The maximum recommended dose for children and adolescents aged 7-12 years is 5 mg/day, and for ages 13-17 years - 20 mg.


Acromegaly .


The initial dose is 1.25 mg (1/2 tablet) 2-3 times/day, later, depending on clinical effect and tolerability, the daily dose of the drug is gradually increased to 10-20 mg (4-8 tablets).


The maximum recommended dose for children and adolescents aged 7-12 years is 10 mg/day, at 13-17 years of age - 20 mg.


Suppression of lactation for medical reasons


On the first day, 1.25 mg (1/2 tablet) 2 times (with meals at breakfast and dinner), then for 14 days - 2.5 mg (1 tablet) 2 times / day. To prevent the onset of lactation, the drug should be started a few hours after childbirth or abortion, but only after vital functions have stabilized. A mild secretion of milk sometimes occurs 2 or 3 days after withdrawal. This can be eliminated by resuming the drug at the same dose for another 1 week.


Beginning postpartum mastitis


The drug is given as 1.25 mg (1/2 tablet) twice daily for the first day (with meals at breakfast and supper), then 2.5 mg (1 tablet) twice daily for 14 days. Additionally an antibiotic is prescribed.


Parkinson's disease


In order to ensure optimal tolerability during the first week, treatment should be started with a low dose of the drug 1.25 mg (1/2 tablet) 1 time/day (preferably in the evening). For selection of individual minimal effective dose it should be increased slowly, by titration method: every week daily dose is increased by 1.25 mg; daily dose is divided into 2-3 doses. An adequate therapeutic response is achieved over an average of 6-8 weeks of treatment. In the absence of clinical effect after 6-8 weeks of use, a further increase in the daily dose by 2.5 mg every week is possible.


The usual therapeutic dose range of bromocriptine for mono- or combination therapy is 10 mg to 40 mg per day, but some patients may require higher doses.


If adverse reactions occur during dose selection, the daily dose should be reduced and maintained at a lower level for at least 1 week. If side effects subside, the dose may be increased again.


It is recommended that patients with movement disorders on levodopa should reduce the dose of levodopa before starting Parlodel. After a satisfactory clinical effect is achieved with Parlodell treatment, further gradual reduction of the levodopa dose may be carried out. Complete withdrawal of levodopa is possible in some patients taking Parlodel.