ORAL PREDNISOLONE SUPPLEMENT ABOLISHES THE ACUTE ADVERSE-EFFECTS FOLLOWING INITIATION OF DEPOT BROMOCRIPTINE THERAPY

OBJECTIVE Although an effective treatment for hyperprolactinaemia, ini tiation of bromocriptine therapy may be associated with significant ac ute side-effects in some patients, particularly nausea, vomiting and p ostural hypotension. These may be minimized by initial treatment with i.m. depot bromocriptine (Parlodel-LAR, Sandoz, Basel, Switzerland), b ut adverse effects following the first injection may still be a signif icant problem. Following the observation that cortisol deficient patie nts were subject to an increased incidence of severe side-effects on i nitiation of bromocriptine therapy, we have evaluated whether concurre nt administration of oral prednisolone to patients without cortisol de ficiency might reduce adverse effects. DESIGN Double-blind placebo-con trolled trial with prednisolone (20 mg) prior to, and 16 hours after, depot injection of i.m. bromocriptine (50 or 100 mg). PATIENTS Twenty- one consecutive patients with hyperprolactinaemia (serum prolactin >10 00 mU/l on 3 separate occasions) who were due to start depot bromocrip tine and who had a normal cortisol response to insulin-induced hypogly caemia. MEASUREMENTS Symptoms at 0, 16 and 40 hours after injection we re assessed using visual linear analogue scales and both inter and int ra-group scores were compared by non-parametric tests. RESULTS Depot b romocriptine was associated with the significant occurrence of light-h eadedness 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 Conc urrent oral administration of prednisolone significantly reduces the i ncidence of acute adverse effects following depot bromocriptine. Two 2 0 mg doses of prednisolone given at 12-hour intervals may be used to a void dopamine-agonist-induced adverse effects at the initiation of tre atment with depot bromocriptine, and may also be of value in the treat ment of side-effects associated with other dopamine agonist drugs.