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." (66, pg.119)Additionally, in looking at all of the cases of MI, the researchers state:"And when we looked through the individual case histories it s really pretty clear thatthis is what you would expect in a group of patients with diabetes.Many of them hadextensive coronary disease, previous bioplast graft surgery, or when they had theirinfarc they went to angiography and then had extensive disease and underwentPTCA." (66, pg.120)Which, roughly translated into English, means that the few MIs which did occurin the diabetics given bromocriptine were not a surprise considering the population.The bromocriptine group showed either the same or a slightly lower incidence of MIthan you d expect to see in diabetics in the first place.Conclusion: the bromocriptineitself did not contribute, there were severe preexisting health problems whichcontributed to the overall risk.Related to this, we might consider that in Parkinson s and acromegalicpatients, who are given much higher doses of bromocriptine, there has been noreport of increased MI risk.It seems difficult to conceive of a situation where 5 mg/dayof bromocriptine would increase the risk of a MI while 40-100 mg/day would not.Simply put, few drugs become safer at higher doses.Considering the known risk ofan MI in a diabetic population, the logical conclusion is that the disease, and not thebromocriptine was the cause of the MIs in these studies. A few comments in summaryFollowing up on the side-effects and safety data above, I want to refer to tworeviews of safety data on bromocriptine.As I mentioned early in this book,bromocriptine has been in clinical use for nearly 30 years, having been introduced forhyperprolactinemia in the 70 s.In the mid-80 s, two reviews were published on theoverall safety of bromocriptine over the previous 10 years of use (69,70).The first review dealt primarily with the use of bromocriptine in females withhyperprolactinemia (69) and concluded that its use was associated with no seriousnegative effects for either the women being treated or their offspring (noting thatbromocriptine was being used to fix fertility problems).The second, and perhaps more interesting review covered the long-term use ofbromocriptine over 1 to 10 years of use (70).It examined the data on 1100 individualswho had been on bromocriptine from 1 to 10 years at doses ranging from 1.25 to80mg/day.It also looked at data on 700 individuals with Parkinson s disease usingdoses from 3.75 to 170 mg/day and in 28 patients with other conditions at doses of2.5 to 20 mg/day.So that s over 1800 people who were on doses of bromocriptinevarying from small (1.25 mg) to huge (170 mg) over a span of 1 to 10 years.The conclusion of this paper pretty much sums it up so I ll quote it in full:"The side-effects of long-term bromocriptine treatment are virtually no different fromthose seen during short-term treatment; most of them are relatively benign, and theyhave been shown in virtually all patients to be reversible.Bromocriptine appears tohave no harmful effects on hepatic, renal, hematologic, or cardiac functions.It isconsidered that a hitherto unknown, severe though rare side-effect of bromocriptine isunlikely to be reported after such long experience." (70, pg.25)Simply put, after so many years of research and clinical use, if bromocriptineweren t extremely safe at the low-doses used for hyperprolactinemia (which aresimilar to the doses described in this booklet for body recomposition or diabetestreatment), we d know about it by now. Minimizing side-effects and riskIn practice, avoidance of the minor side-effects is best accomplished bystarting with a partial/low dose and increasing every 3-7 days until the full desireddose is reached.In the diabetes studies, starting with that low dose and building upavoided most of the side-effects that typically occur.Proper timing is also a key tominimizing the side-effects.I ve mentioned once or twice that bromocriptine shouldbe taken in the morning but want to reiterate it here.Taking bromocriptine at night willtend to maximize the side-effects without really doing anything to improve the benefits.Additionally, considering the effects of bromocriptine in slightly decreasingblood glucose, taking bromocriptine with meals, preferably with at least a smallamount of carbohydrates should help to limit problems.Obviously, dieters who aretraining intensely (think contest bodybuilders or other athletes) should be even morecareful.Overtraining can throw off normal physiology and cause dehydration, fatigue,low blood glucose, etc.when combined with dieting.Adding bromocriptine to the mixcould potentially make that worse (see the final section of this chapter for a sterlingexample of how not to use bromocriptine)
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