門 診 處 方 討 論 Bromocriptine用於Polycystic ovary syndrome 報告者 : 陳淑燕 94.03.03
12/23 Clomiphene 50mg/tab 1# TID x 5 days 1. Polycystic ovaries 2. Irregular menstrual cycle 12/23 Clomiphene 50mg/tab 1# TID x 5 days Metformin 500mg/tab 1# TID x 21 days Bromocriptine 2.5mg/tab 1# BID x 21 days Topaal 1# TID x 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 臨床表徵包括月經異常、排卵異常、不孕症、肥胖、多 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 1.39-24.2 35.17
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 。 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.