Transcript Bromocriptine用於Polycystic ovary syndrome

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Bromocriptine用於Polycystic
ovary syndrome
報告者 : 陳淑燕
94.03.03
/23
1. Polycystic ovaries
2. Irregular menstrual cycle
Clomiphene 50mg/tab
Metformin 500mg/tab
Bromocriptine 2.5mg/tab
Topaal
1# TID
1# TID
1# BID
1# TID
x
x
x
x
5 days
21 days
21 days
21 days
多囊性卵巢症候群 PCOS
 多囊性卵巢的病人通常並沒有真正的排卵，而出現的月
經是屬於無排卵性的，超音波檢查卵巢會呈現許多小囊
的情形，其實每一個小囊就是一個小的卵泡.
 臨床表徵包括月經異常、排卵異常、不孕症、肥胖、多
毛症及痤瘡等.
 致病原因至今仍不清楚,所以治療的目標只能針對每個
病患的症狀來處理.
多囊性卵巢症候群 PCOS
 發現許多PCOS 患者的血中insulin及
prolactin過高，所以使用胰島素激敏劑
（insulin-sensitizing agents）的降血糖藥物
（如：metformin、 troglitazone）及抑制泌乳
素分泌藥物如 bromocriptine等以改善其症
狀.
使用前
Prolactin
35.17
1.39-24.2
使用後
Prolactin
25.64
Prolactin 的 作 用
 Prolactin的主要生理功能是刺激乳房組織生長，
製造和分泌乳汁 。
 Prolactin過高的臨床表徵：
典型的症狀包括有動情素低(Hypoestrogenism)、
繼發性無月經 ( Secondary amenorrhea ) 、溢
乳 (Galactorrhea)、多毛症、多囊性卵巢症、不
孕等。
Bromocriptine 於 PCOS 治療之機轉
 Bromocriptine is an ergot derivative and a
direct-acting Dopamine agonist .
 Bromocriptine stimulates hypothalamic
dopaminergic receptors resulting in an
increase in prolactin inhibitor factor, decreasing
secretion of prolactin from the anterior pituitary .
Bromocriptine於PCOS治療之臨床證據(1)

In a randomized, double-blind study of 55
patients with polycystic ovary disease, similar
improvements in ovulatory function were seen
with BROMOCRIPTINE (53%) versus placebo
(40%). The patients were given tablets
containing BROMOCRIPTINE 2.5 milligrams or
placebo starting at one-half tablet 2 times a day
and increasing to 1 tablet twice daily if 2
ovulatory cycles had not occurred in 3 months.
Treatment continued for at least 6 months.
( Buvat et al, 1986 )
The only clear effect of chronic BROMOCRIPTINE
administration was that serum prolactin levels
were lowered. Many other changes were identical
to those seen in the group treated with placebo,
including a decrease in elevated serum LH and
androgen levels, restoration of cyclical menstrual
function and regular ovulation.

( Buvat et al, 1986 )
Bromocriptine於PCOS治療之臨床證據(2)
The combination of Clomiphene 50 to 100 mg
(from cycle day 5 to 9), Dexamethasone 0.5 to 1
mg/day and Bromocriptine 2.5 to 5 mg daily was
reported effective in the treatment of resistant
polycystic ovarian disease in 8 women.
 Some patients were also resistant to human
menopausal gonadotropin and human chorionic
gonadotropin. All patients were anovulatory prior
to combination therapy.
(Homburg et al, 1988)
 Decreases in the leutinizing hormone:follicle
stimulating hormone ratio were observed, as
well as reductions in prolactin and androgen
levels to normal. All 8 patients became pregnant
within 5 to 11 treatment cycles and ultimately
delivered normal babies.
 It is recommended that the combination be
considered in resistant cases of polycystic
ovarian disease.
(Homburg et al, 1988)
Bromocriptine應用於PCOS治療之劑量
 The initial recommended dosage is 1.25 to 2.5
mg daily. An additional 2.5 mg may be added
as tolerated every 3 to 7 days until an optimal
therapeutic response is achieved. Up to
15mg/day.
 結論建議劑量: 2.5mg BID ~ TID
Bromocriptine應用於PCOS治療之注意事項
 副作用 (包括頭暈，姿態性低血壓和噁心) 常常發
生在治療的早期，可以靠以低劑量起始和持 續
性服用而避免發生。
 Bromocriptine對大多數的女性病人可以恢復懷孕能
力，因此，假如不想懷孕的話，避孕措施必須做好。
Bromocriptine 於 PCOS 之 結 論
 FDA APPROVAL: Adult, no; pediatric, no
 EFFICACY: Adult, possibly effective
 DOCUMENTATION: Adult, good
Referevence: Micromedex Inc. drug evaluation Monographs. 2004.
Reference
1. Micromedex Inc. drug evaluation Monographs. 2004
2. Homburg R, Ashkenazi J & Goldman J: Resistant cases of polycystic
ovarian disease successfully treated with a combination of corticosteroids,
clomiphene, and bromocriptine. Int J Fertil 1988; 33:393-397.
3. Buvat J, Buvat-Herbaut M, Marcolin G et al: A double blind controlled
study of the hormonal and clinical effects of bromocriptine in the
polycrystic ovary syndrome. J Clin Endocrinol Metab 1986; 63:119-124.
4. Drug information handbook 2003-2004.