Dopamine Agonist Selector
Select your condition and preferences to find the best dopamine agonist:
TL;DR
- Parlodel (bromocriptine) is a cheap, older dopamine agonist best for prolactinoma and Parkinson’s early stages.
- Cabergoline offers longer dosing intervals and fewer side‑effects but costs more.
- Quinagolide is non‑ergot and useful when ergot‑related nausea is a problem.
- Pergolide is largely withdrawn due to cardiac risks; avoid unless no other option.
- Pramipexole works on different dopamine receptors and is preferred for restless‑leg syndrome.
Why a side‑by‑side look matters
If you or a loved one have been prescribed Parlodel (Bromocriptine), you’ve probably seen a long list of possible alternatives. The market is crowded with ergot‑derived and non‑ergot dopamine agonists, each with its own dosing schedule, side‑effect profile, and price tag. Deciding which pill fits your life isn’t just about “cheaper vs. more expensive”; it’s about matching the drug’s pharmacology to your condition, lifestyle, and tolerance.
This guide walks you through the most common alternatives, compares key attributes, and helps you ask the right questions at the pharmacy or during your next doctor visit.
How bromocriptine works - the science in plain English
Bromocriptine is an ergot‑derived dopamine D2‑receptor agonist. By binding to D2 receptors in the pituitary gland, it suppresses prolactin secretion, which shrinks prolactin‑producing tumors (prolactinomas) and reduces menstrual disturbances, galactorrhea, and infertility in women. In Parkinson’s disease, it mimics dopamine, helping to restore the motor control that the brain loses.
Key pharmacokinetic facts:
- Half‑life: ~12hours (requires multiple daily doses).
- Onset: 30minutes for gastrointestinal effects, 2‑4weeks for hormonal changes.
- Metabolism: Primarily hepatic via CYP450 enzymes (especially CYP1A2).
Because it’s an ergot alkaloid, bromocriptine can cause vasoconstriction‑related side‑effects like nausea, orthostatic hypotension, and rare heart valve issues.
When doctors choose bromocriptine
Typical indications include:
- Prolactinoma (micro‑ and macro‑tumors).
- Adjunct therapy for type‑2 diabetes (off‑label, improves glucose tolerance).
- Early‑stage Parkinson’s disease, especially when cost is a concern.
- Acromegaly (as an adjunct to surgery).
It’s often preferred when patients need a low‑cost option, have insurance coverage that favours older generics, or when clinicians want a drug with a long safety record (despite the ergot‑related warnings).
Major alternatives at a glance
Below are the most common dopamine agonists you’ll encounter. Each has its own brand name, receptor selectivity, and dosing convenience.
- Cabergoline - non‑ergot, long‑acting D2 agonist, taken once or twice weekly.
- Quinagolide - non‑ergot, short‑acting D2 agonist, taken daily, prized for minimal nausea.
- Pergolide - ergot‑derived, once‑daily, largely withdrawn in many countries due to cardiac fibrosis.
- Pramipexole - non‑ergot, D2/D3 agonist, used for Parkinson’s and restless‑leg syndrome, taken three times daily.
Decision criteria you should weigh
When you compare bromocriptine with the alternatives, focus on these five axes:
- Indication match - Does the drug have proven efficacy for your specific condition?
- Dosing convenience - Frequency and titration steps matter for adherence.
- Side‑effect profile - Nausea, hypotension, cardiac issues, impulse control disorders.
- Cost and insurance coverage - Generic availability versus brand‑only pricing.
- Drug interactions - CYP metabolism, contraindications with antihypertensives or antidepressants.
Side‑by‑side comparison table
| Attribute | Parlodel (Bromocriptine) | Cabergoline | Quinagolide | Pergolide | Pramipexole |
|---|---|---|---|---|---|
| Class | Ergot‑derived D2 agonist | Non‑ergot D2 agonist | Non‑ergot D2 agonist | Ergot‑derived D2 agonist | Non‑ergot D2/D3 agonist |
| Typical uses | Prolactinoma, early Parkinson’s, type‑2 diabetes (off‑label) | Prolactinoma, Parkinson’s | Prolactinoma (when nausea is a problem) | Prolactinoma (limited availability) | Parkinson’s, Restless‑Leg Syndrome |
| Dosage frequency | 2‑4times daily | Once or twice weekly | Once daily | Once daily | Three times daily |
| Half‑life | ~12h | 65‑80h | ~6h | ~24h | 8‑12h |
| Common side‑effects | Nausea, headache, hypotension, rare valvulopathy | Less nausea, headache, dizziness | Minimal nausea, fatigue | Severe nausea, possible cardiac fibrosis | Swelling, daytime sleepiness, impulse control disorders |
| Cost (UK, generic) | £0.10‑£0.20 per tablet | £2‑£4 per tablet (brand) | £1‑£2 per tablet | Often unavailable, expensive | £1.50‑£3 per tablet |
| Regulatory status (UK) | Licensed, generic | Licensed, brand | Licensed, brand | Withdrawn in many regions | Licensed, brand |
Which drug fits which scenario?
Scenario 1 - You need a low‑cost option for a small prolactinoma. Bromocriptine’s cheap price and extensive safety data make it the go‑to. Expect to take it 2‑3 times a day and monitor blood pressure during the titration phase.
Scenario 2 - You hate taking pills multiple times a day. Cabergoline’s once‑or‑twice‑weekly dosing is a game‑changer for busy professionals. The trade‑off is a higher price and a need for periodic echocardiograms because of rare valve concerns.
Scenario 3 - Nausea from ergot drugs has ruined your compliance. Quinagolide eliminates most gastrointestinal complaints because it’s non‑ergot. It’s taken once daily but requires careful liver function monitoring.
Scenario 4 - You have Parkinson’s and also restless‑leg syndrome. Pramipexole covers both motor symptoms and leg restlessness, but be ready for potential daytime sleepiness and impulse‑control urges.
Scenario 5 - You live in a country where cabergoline isn’t reimbursed. Bromocriptine may be the only affordable generic, even though you’ll need multiple daily doses.
Practical tips and pitfalls
- Start low, go slow. All dopamine agonists cause nausea early on. Beginning with ¼ of the target dose and titrating every 3‑5 days reduces drop‑out rates.
- Watch blood pressure. Bromocriptine and quinagolide can cause orthostatic hypotension, especially when you stand up quickly after meals.
- Cardiac monitoring. For cabergoline and pergolide, schedule an echocardiogram at baseline and then annually if you stay on therapy beyond 2years.
- Drug interactions. Avoid combining bromocriptine with potent CYP1A2 inhibitors (e.g., fluvoxamine) without dose adjustment.
- Pregnancy planning. Dopamine agonists are generally unsafe in pregnancy; discuss a wash‑out period with your endocrinologist if you plan to conceive.
- Impulse control check. Pramipexole and cabergoline have been linked to compulsive gambling or shopping. Report any new urges promptly.
How to discuss options with your doctor
Bring a simple checklist to the appointment:
- What is my primary diagnosis and severity?
- Do I have any heart or liver conditions?
- How many times a day can I realistically take medication?
- What does my insurance cover?
- Am I willing to undergo regular cardiac scans?
Answering these helps the clinician narrow down the best dopamine agonist for you.
Frequently Asked Questions
Can I switch from bromocriptine to cabergoline?
Yes, but the switch requires a short wash‑out period (usually 24‑48hours) and a lower starting dose of cabergoline. Your doctor will monitor prolactin levels and any cardiac changes during the transition.
Why does bromocriptine cause nausea?
Bromocriptine stimulates dopamine receptors in the chemoreceptor trigger zone, which can trigger vomiting pathways. Starting at a low dose and taking the pill with food usually eases the problem.
Is cabergoline safe for long‑term use?
Most patients tolerate cabergoline well for years, but rare cases of heart‑valve thickening have been reported. Annual echocardiograms are recommended after two years of therapy.
Can quinagolide be used in pregnancy?
Quinagolide is classified as pregnancy category B in the UK, meaning animal studies showed no risk but human data are limited. It should be avoided unless the benefit clearly outweighs potential harm.
What should I do if I develop impulse‑control problems on a dopamine agonist?
Stop the medication immediately and contact your neurologist or endocrinologist. A dose reduction or switch to a different class (e.g., levodopa) often resolves the issue.
Next steps for you
Take a moment to list your top three priorities (cost, convenience, side‑effects). Then match them against the table above. If bromocriptine ticks the cost box but you struggle with dosing frequency, ask your doctor about a low‑dose cabergoline trial. If you’re primarily worried about nausea, quinagolide might be worth a look.
Finally, keep a symptom diary for at least two weeks after starting any dopamine agonist. Note blood pressure, any nausea, mood changes, and, importantly, any new cravings or compulsive behaviours. Bring that diary to your next appointment - it’s the fastest way to tailor your therapy.
All Comments
Namrata Thakur September 28, 2025
Starting bromocriptine can feel overwhelming, but breaking it down into small steps helps a lot.
First, take the pill with a full glass of water and a light breakfast to soften the nausea.
Second, begin with the lowest dose your doctor prescribed and increase slowly every few days.
Third, keep a simple diary of any dizziness, blood‑pressure changes, or headaches so you can show it to your endocrinologist.
Finally, remember that the cheap price of Parlodel often outweighs the inconvenience of multiple daily doses, especially if you’re on a tight budget.
Sticking to this routine will make the treatment smoother and keep you on track.
Aman Vaid September 28, 2025
The pharmacokinetic profile you described is accurate: bromocriptine’s half‑life is approximately twelve hours, which indeed necessitates dosing two to three times daily.
However, note that hepatic metabolism via CYP1A2 can be inhibited by common agents such as fluvoxamine, potentially raising plasma concentrations and exacerbating side effects.
Therefore, a dose adjustment may be required when co‑administered with such inhibitors.