Bromocriptine vs Cabergoline
How to tell Bromocriptine and Cabergoline apart when a board question makes them look alike.
Both lower prolactin through D2 agonism; bromocriptine is shorter and pregnancy-familiar, cabergoline is longer and usually better tolerated.
Side by side
Shorter-acting dopamine D2 agonist with long pregnancy/fertility experience in hyperprolactinemia.
Longer-acting dopamine D2 agonist often favored for prolactinomas because of stronger prolactin suppression and convenient twice-weekly dosing.
Bromocriptine activates dopamine D2 receptors on lactotrophs, suppressing prolactin release.
Cabergoline also activates D2 receptors but has a longer half-life and higher D2 selectivity.
Hyperprolactinemia with fertility/pregnancy-experience wording points bromocriptine.
Prolactinoma shrinkage with twice-weekly dosing points cabergoline.
The trap
Do not confuse dopamine agonists with dopamine blockers; dopamine blockers can raise prolactin.
The repair move
For drugs touching prolactin, decide direction first: (1) dopamine AGONIST (bromocriptine, cabergoline) LOWERS prolactin and shrinks prolactinomas first-line treatment for prolactinoma even when the tumor is large because dopamine agonist therapy alone produces significant tumor shrinkage; (2) dopamine ANTAGONIST (typical and atypical antipsychotics, metoclopramide) RAISES prolactin as a side effect. Between the agonists: bromocriptine is shorter-acting, longer track record, preferred when pregnancy is anticipated (more reproductive safety data); cabergoline is longer-acting (twice weekly dosing), better tolerated (less nausea and orthostasis), and generally more effective for prolactin lowering but carries a small risk of cardiac valve fibrosis at high doses (relevant in Parkinson disease dosing, not typical prolactinoma doses).
Try a free question
CoreA patient with hyperprolactinemia from a prolactinoma starts a dopamine agonist taken twice weekly. Prolactin falls and tumor size decreases. Which drug best fits?
Show answer and explanation
Answer: B. Cabergoline. Cabergoline is a long-acting dopamine D2 agonist often favored for prolactinomas because of efficacy and convenient dosing.
Why the other choices are tempting
- A. Bromocriptine is also a dopamine agonist but is shorter acting and less convenient.
- C. Octreotide is a somatostatin analog used for acromegaly and neuroendocrine secretory syndromes.
- D. Leuprolide is a GnRH agonist.
- E. Metoclopramide is a dopamine antagonist that can raise prolactin.
Flashcards
Tap a card to flip it.
What is the fastest separator for Bromocriptine vs Cabergoline?
Both lower prolactin through D2 agonism; bromocriptine is shorter and pregnancy-familiar, cabergoline is longer and usually better tolerated.
What clue should make you choose Bromocriptine?
Shorter-acting dopamine D2 agonist with long pregnancy/fertility experience in hyperprolactinemia.
Quick answers
What is the fastest way to tell Bromocriptine from Cabergoline?
Both lower prolactin through D2 agonism; bromocriptine is shorter and pregnancy-familiar, cabergoline is longer and usually better tolerated.
What is the key clue for Bromocriptine?
Shorter-acting dopamine D2 agonist with long pregnancy/fertility experience in hyperprolactinemia.
What is the key clue for Cabergoline?
Longer-acting dopamine D2 agonist often favored for prolactinomas because of stronger prolactin suppression and convenient twice-weekly dosing.
What is the common trap with Bromocriptine vs Cabergoline?
Do not confuse dopamine agonists with dopamine blockers; dopamine blockers can raise prolactin.