A 48-year-old woman has been treated for 10 years with bromocriptine (Pravidel) 2.5 mg half a table

Fråga: A 48-year-old woman has been treated for 10 years with bromocriptine (Pravidel) 2.5 mg half a tablet twice daily because of hyperprolactinaemia. The patient arrived at the hospital with a severe ventricular arrythmia for which no obvious explanation has been found. No other drugs are taken besides Pravidel but the patient is taking a natural product drug, Preglandin (Evening Primrose oil), and started doing so two weeks earlier. Is Pravidel known to induce ventricular arrythmias?

Sammanfattning: Apart from one case of VES reported to the Swedish Side-Effect Register there have been no cases of ventricular arrythmias due to bromocriptine reported. In this case the patient has been on medication for ten years and it must therefore be considered unlikely that bromocriptine was the cause of the ventricular arrythmias experienced by the patient.

Svar: In reference literature, bromocriptine has been considered mainly as a drug reducing blood pressure leading to dizziness or syncope. Occasional cases of bradycardia and acute left ventricular failure has been described. Angina pectoris can also be aggravated by bromocriptine in some cases (1). In a previous question a case with atrial fibrillation was described, though the patient also took levodopa which is known to be arrythmogenic (2). In the files of the Swedish Adverse Drug Reactions Advisory Committee, SADRAC, there are nine reports of circulatory side-effects, one of which is VES (3). A search in Medline did not provide any information concerning the arrythmogenic effect of bromocriptine but instead cases in which the drug had been used to treat ventricular arrythmias (4). We are not aware of any cases of ventricular arrythmias described as side-effects of natural products such as Preglandin (Evening Primrose oil) though it should be considered that this case be reported to the Swedish Medical Product Agency.