Bromocriptine - instructions for use, dose, side effects, contraindications

Excipients: lactose monohydrate - 55.63 mg, cellulose microcrystalline - 20.0 mg, potato starch - 15.0 mg, sodium carboxymethyl starch - 2.0 mg, povidone-K25 - 3.5 mg, magnesium stearate - 1.0 mg.

Description:

TOrifle, flat-cylindrical tablets, with a risk on one side and chamfers from two sides, white or almost white.

Pharmacotherapeutic group:Dopamine receptor agonist

ATX: & nbsp

N.04.B.C Stimulants of dopamine receptors

N.04.B.C.01 Bromocriptine

Pharmacodynamics:

Bromocriptine is an ergot derivative, an agonist (D₂) of dopamine receptors. Reduces the secretion of prolactin in the anterior pituitary gland and does not affect the production and release of other pituitary hormones, except for patients with acromegaly, in whom bromocriptine reduces the concentration of growth hormone. In the postpartum period, prolactin is needed to start and maintain lactation. In other periods of life, an increase in prolactin secretion leads to pathological lactation (galactorrhea) and / or disorders of ovulation and the menstrual cycle.

Bromocriptine, being a specific inhibitor of prolactin secretion, can It is used to prevent or suppress physiological lactation, as well as to treat pathological conditions caused by prolactin hypersecretion.

With amenorrhea and / or anovulatory menstrual cycles (accompanied or not accompanied by galactorrhea), bromocriptine normalizes the function of the ovaries, restoring endocrine regulation at the level of the ovaries - the pituitary gland.

Bromocriptine does not disrupt the postnatal involution of the uterus and does not increase the risk of thromboembolism.

In the syndrome of polycystic ovaries, the drug reduces the severity of clinical manifestations.

Bromocriptine stops growth or decreases the size of prolactin secreting adenomas (prolactin).

In patients with acromegaly, in addition to reducing the concentration of growth hormone and prolactin in the blood plasma, bromocriptine has a beneficial effect on clinical manifestations and glucose tolerance.

With Parkinson's disease, characterized by a lack of dopamine in some structures of the brain, bromocriptine is used in higher doses than for the treatment of endocrine diseases. Bromocriptine stimulates the receptors of dopamine, contributing to the restoration of the neurochemical balance in these structures. When bromocriptine is used, the severity of symptoms of depression, often observed in patients with Parkinsonism, decreases; tremor; rigidity; akinesia and gait disturbance at all stages of the disease.

Bromocriptine can lower blood pressure (BP), but the mechanism of this action remains unclear. Perhaps this effect is a consequence of the agonistic effect on the central dopamine receptors, the result of which is a decrease in vascular tone, as well as a decrease in the concentration of catecholamines in the blood plasma and, thus, indirectly bromocriptine acts as a vasodilator.

Pharmacokinetics:

Absorption

Absorption after oral administration is 25-30%. The maximum concentration in blood plasma is reached within 1-3 hours.After ingestion of bromocriptine in a dose of 5 mg, the maximum concentration in the blood plasma is 0.465 ng / ml. The prolactin-lowering effect begins 1-2 hours after taking the drug inside, reaching a maximum after 5-10 hours (a decrease in prolactin concentration is about 80%), and remains approximately at this level for 8-12 hours.

Distribution

The binding of bromocriptine to plasma proteins is 96%.

Metabolism

Bromocriptine undergoes intensive metabolism in the liver with "primary passage" with the formation of a number of metabolites. Its bioavailability is 6%. In studies in vitro it was shown that bromocriptine has a high affinity for the enzyme CYP3A. Inhibitors and / or competing substrate for CYP3A4 can slow the metabolism of bromocriptine and increase its concentration in the blood plasma. Influence on bromocriptine metabolism of microsomal liver oxidation enzymes such as CYP2D6, CYP2C8, CYP2C19 has not been studied. Bromocriptine is an inhibitor CYP3A4.

Excretion

Removal of unchanged drug from the blood plasma biphasic, the final half-life is about 15 hours (8 to 20 hours).

Bromocriptine and its metabolites are almost completely excreted through the intestine, only 6% is excreted by the kidneys.

Pharmacokinetics in selected patient groups

In patients with impaired hepatic function, the rate of bromocriptine elimination can be slowed down, and the concentration in the blood plasma may increase, which requires correction of the dose. The effect on the pharmacokinetics of bromocriptine and its metabolites of age, race and sex has not been studied.

Indications:

Violations of the menstrual cycle, female infertility:

- Prolactin-dependent diseases and conditions, accompanied or not accompanied by hyperprolactinaemia: amenorrhea (accompanied and not accompanied by galactorrhea); oligomenorrhoea; Luteal phase insufficiency; secondary hyperprolactinaemia in the presence of medications (eg, certain psychoactive or hypotensive drugs);

- Prolactin-independent female infertility: a syndrome of polycystic ovaries; anovulatory cycles (in addition to anti-estrogens, for example clomiphene).

Premenstrual syndrome: tenderness of the mammary glands; edema associated with the phase of the cycle; flatulence; mood disorders.

Hyperprolactinemia in men: Prolactin-dependent hypogonadism (oligospermia, loss of libido, impotence).

Prolactinomas: conservative treatment of prolactin secreting micro- and macroadenomas of the pituitary gland; preoperative preparation to reduce the volume of the tumor and facilitate its removal; Postoperative treatment if the level of prolactin remains elevated.

Acromegaly: as an additional drug in combination with radiotherapy and surgical treatment, or, in special cases, as an alternative to surgical or radiotherapy.

Suppression of lactation: prevention or cessation of postpartum lactation due to medical conditions: prevention of lactation after abortion; postpartum engorgement of the mammary glands; beginning postpartum mastitis.

Benign breast diseases: mastalgia (in isolated form, as well as in combination with premenstrual syndrome), mastalgia with benign nodular or cystic gland changes; benign nodular and / or cystic changes, especially fibrocystic mastopathy.

Parkinson's disease: all stages of idiopathic Parkinson's disease and postencephalitic parkinsonism (in the form of monotherapy, or in combination with other antiparkinsonian drugs).

Contraindications:

- Hypersensitivity to bromocriptine or to any of the auxiliary components of the drug, or other ergot alkaloids;

- uncontrolled arterial hypertension;

- ulcerative lesions of the gastrointestinal tract and gastrointestinal bleeding;

- severe hepatic impairment;

- cerebrovascular diseases in the anamnesis;

- sepsis;

- obliterating endarteritis; Raynaud's syndrome; temporary arteritis;

- Abuse of tobacco smoking;

- simultaneous application with methylergometrin and other ergot alkaloids, moderate or potent inhibitors of cytochrome P450 (for example, itraconazole, voriconazole, clarithromycin);

- postpartum period in women with severe cardiovascular illnesses in the anamnesis;

- simultaneous use with vasoconstrictive drugs in women in the postpartum period;

- gestosis of the second half of pregnancy (including preeclampsia, eclampsia);

- arterial hypertension during pregnancy and in the puerperium;

- ischemic heart disease and other diseases of the cardiovascular system of a serious degree (including unstable angina, heart valve disease (for long-term treatment));

- severe mental disorders (including history);

- rare hereditary forms of lactose intolerance, lactase deficiency, glucose-galactose malabsorption (because the formulation contains lactose).

The safety and efficacy of bromocriptine in children younger than 7 years is not confirmed.

Carefully:

Carefully apply in patients with cardiovascular diseases (for example, with arterial hypertension, arrhythmias, the presence of myocardial infarction in history); impaired liver and kidney function; Parkinsonism with symptoms of dementia; porphyria; ulcerative lesions of the gastrointestinal tract in the anamnesis; in children and adolescents older than 7 years; in patients older than 65 years; in the postpartum period.

Particular care should be taken when using the drug Bromocriptine in patients who have recently taken drugs that affect blood pressure, such as vasoconstrictors (sympathomimetics, ergot alkaloids, including ergometrine or methylergomethrin).

Pregnancy and lactation:

Treatment with bromocriptine during pregnancy should be discontinued, except when the potential effect of treatment exceeds the possible risk for the fetus (with large and rapidly growing pituitary tumors). Admission of bromocriptine in the first 8 weeks of pregnancy does not have a harmful effect on the course and outcome of pregnancy. After discontinuing the drug, the risk of abortion does not increase.

Bromocriptine reduces the secretion of milk, so its use is not recommended during breastfeeding.

Dosing and Administration:

Inside. A drug Bromocriptine should always be taken while eating.

Typically, treatment begins with a small dose, which is then gradually increased to achieve the optimal effect.

The maximum daily dose is 30 mg.

Violations of the menstrual cycle, female infertility

1/2 tablet (1.25 mg) 2-3 times a day; if the effect is insufficient, the dose of the drug is gradually increased to 5-7.5 mg (2-3 tablets) per day before the normalization of the menstrual cycle and / or restoration of ovulation. To prevent relapse, treatment can continue for several menstrual cycles.

Hyperprolactinemia in men

1/2 tablets (1.25 mg) 2-3 times a day, gradually increasing the dose by 1.25 mg to 5-10 mg (2 to 4 tablets) with an interval of 2-3 weeks.

Prolactinoma

1/2 tablets (1.25 mg) 2-3 times a day, gradually increasing the dose to several tablets per day, necessary to maintain an adequate decrease in the concentration of prolactin in the blood plasma. The maximum recommended dose for children and adolescents aged 7-12 years is 5 mg / day, at the age of 13-18 years - 10 mg / day.

Acromegaly

The initial dose is 1/2 tablet (1.25 mg) 2-3 times a day, then, if necessary, gradually increase the dose to several tablets per day, further, depending on the clinical effect and side effects, the daily dose of the drug is gradually increased to 10 -20 mg (4-8 tablets). The maximum daily dose in children aged 7 to 12 years is 10 mg. The maximum daily dose in adolescents (13-18 years) is 10 mg.

Suppression of lactation for medical reasons

On the first day, use 1/2 tablet (1.25 mg) 2 times (during meals at breakfast and dinner), then within 14 days - 1 tablet (2.5 mg) 2 times a day. Treatment should be started several hours after childbirth or abortion, however, but not earlier than 4 hours after stabilization of vital functions. After 2-3 days after the drug is withdrawn, there is sometimes a slight secretion of milk.It is removed by resuming the drug at the same dose for another week.

Beginning postpartum mastitis

Apply the same scheme as when suppressing lactation. After three days, the symptoms of inflammation disappear and if the mother decides to resume breastfeeding the baby, the treatment is stopped. Otherwise, the treatment is continued 1 tablet 2 times a day for 11 days. If necessary, prescribe antibiotics.

Postpartum engorgement of mammary glands

2.5 mg once, after 6-12 hours the dose can be repeated if necessary, there is no undesirable stopping of lactation.

Parkinson's disease

The drug is prescribed for patients with Parkinson's disease in the following cases:

in case of ineffective treatment with levodopa and inhibitor of decarboxylase;
in the initial stage of treatment, in combination with levodopa / carbidopa.

Treatment begins with low doses, which are slowly increased until the maximum therapeutic effect is achieved. Usually, the patient takes the initial dose of the drug (1.25 mg, i.e., 1/2 tablet) at bedtime, for 1 week. Then, the dose of the drug should be slowly increased to the minimum effective dose for each patient.The daily dose should be increased by 2.5 mg with an interval of 1 week to a maximum daily dose of 30 mg. The daily dose is divided into 2-3 doses. An adequate therapeutic result can be achieved within 6-8 weeks of treatment. If this does not happen, the daily dose can be increased further - every week by 2.5 mg / day.

If the choice of a dose of the drug Bromocriptine there is a development of undesirable reactions, then the daily dose should be temporarily reduced and maintained at such a low level for at least 1 week. With a reduction in unwanted reactions, the daily dose of the drug can be increased again.

In patients who developed levodopa against movement with the use of levodopa, it is recommended to reduce the dose of levodopa before the start of therapy with the drug Bromocriptine.

At the beginning of treatment of patients with Parkinson's disease with bromocriptine and levodopa, the side effects of levodopa appear later than when taking only levodopa. At the beginning of treatment, the doses of both drugs are low - they are adjusted gradually and in turn. At the beginning of the combination therapy for Parkinson's disease the average dose of the drug is 15-30 mg, whereas levodopa is 250 mg.With a gradual increase in the dose of the drug Bromocriptine The dose of levodopa should also be gradually reduced. In some patients, the use of levodopa can be discontinued completely.

Application in children and adolescents

Safety and effectiveness in children under 7 years is not confirmed, so the use of the drug Bromocriptine in this age group is contraindicated.

In children and adolescents aged 7 to 18 years, the use of the drug Bromocriptine with disorders of the menstrual cycle, female infertility, hyperprolactinaemia, postpartum mastitis, suppression of lactation due to medical conditions and Parkinson's disease is contraindicated.

Use in elderly patients

Given the decreased function of the liver, kidneys, cardiac function; the presence of concomitant diseases and the use of concomitant drug therapy, the drug should be used with caution in elderly patients. Begin and conduct therapy with the drug Bromocriptine it is necessary in the lowest effective dose.

Use in patients with renal insufficiency

Studies of the efficacy and safety of bromocriptine in patients with renal insufficiency have not been conducted. Because the bromocriptine and its metabolites are almost completely eliminated through the intestine, correction of its dose in patients with renal insufficiency is not required.

Use in patients with hepatic impairment

In patients with impaired hepatic function, the rate of bromocriptine elimination can be slowed down, and the concentration in the blood plasma may increase, which requires correction of the dose. The use of bromocriptine in patients with severe hepatic insufficiency is contraindicated.

Side effects:

According to the World Health Organization (WHO), adverse reactions are classified according to their frequency of development as follows: often (≥1/100, <1/10), infrequently (≥1/1000, <1/100), rarely (≥1/10000, <1/1000), rarely (<1/10000), including individual messages, unknown - frequency is unknown. The risk of undesired reactions can be minimized by a gradual increase or decrease in the dose, followed by a more gradual titration.

Disorders from the psyche: infrequent - depressed mood, confusion, psychomotor agitation, hallucinations; rarely - psychosis.

Impaired nervous system: often - headache, dizziness, drowsiness; infrequently - dyskinesia; rarely - paresthesia, insomnia; very rarely - a sudden falling asleep.

Disorders from the side of the organ of vision: rarely - decreased visual acuity, "clouding" the view.

Hearing disorders and labyrinthine disorders: rarely - ringing, noise in the ears.

Heart Disease: rarely - when applying large doses - pericardial effusion, constrictive pericarditis, cardiac rhythm disorder (arrhythmia), bradycardia, tachycardia; myocardial infarction; very rarely - the pathology of the heart valves (including regurgitation of blood); unknown - the progression of angina pectoris.

Vascular disorders: infrequently - marked decrease in blood pressure (very rarely leading to fainting); rarely - increased blood pressure; stroke; peripheral angiospasm; rarely - the reversible pallor of the fingers on the hands and feet, caused by hypothermia; with long-term use - Raynaud's syndrome.

Disturbances from the respiratory system, chest and mediastinal organs: often - nasal congestion; rarely - when using large doses - pleural effusion, pleural fibrosis, pleurisy, pulmonary fibrosis, dyspnea.

From the gastrointestinal tract (GIT): often - nausea, vomiting, constipation; infrequent - dryness of the oral mucosa; rarely - caries, periodontal disease,candidiasis of the oral cavity, diarrhea, with prolonged treatment with high doses - abdominal pain, retroperitoneal fibrosis, gastrointestinal ulcer, gastrointestinal bleeding (black stool, blood in vomit masses).

Disturbances from the skin and subcutaneous tissues: infrequently - allergic dermatitis, alopecia.

Disturbances from the musculoskeletal and connective tissue: infrequently - cramps of the muscles of the lower extremities.

Disorders from the kidneys and urinary tract: infrequently - urinary incontinence.

General disorders and disorders at the site of administration: infrequently - increased fatigue; rarely - peripheral edema.

Rarely in the case of a sudden discontinuation of the drug may develop a condition similar to a malignant neuroleptic syndrome.

Patients with Parkinson's disease with high doses of bromocriptine may develop a pathological attraction to gambling, increased libido and hypersexuality, usually reversible after dose reduction or drug withdrawal.

When using the drug to suppress physiological lactation in the postpartum period, in rare cases, increased blood pressure, myocardial infarction, stroke, seizures or mental disorders.

Overdose:

Symptoms: nausea, vomiting, headache, changes in blood pressure, with a decrease in blood pressure, a weak pulse, rapid heartbeat, cold extremities, chest pain, drowsiness, confused consciousness, hallucinations.

Treatment: symptomatic. During the first three hours after taking the drug, gastric lavage, the use of activated charcoal to reduce the absorption of the drug from the gastrointestinal tract.

Interaction:

When used simultaneously with oral contraceptives, the concentration of prolactin in the blood plasma increases.

It is not recommended to appoint ergot with other alkaloids.

Enhances the effects of levodopa, hypotensive drugs. The effectiveness of bromocriptine may decrease with simultaneous admission dopamine agonists (phenothiazines, butyrophenones) or tricyclic antidepressants (imipramine, amitriptyline).

Inhibitors monoamine oxidase, furazolidone, loxapine, methyldopa, metoclopramide, reserpine, thioxanthins and phenothiazines increase the concentration of bromocriptine in the blood plasma and the risk of side effects.

When used simultaneously with ritonavir a 50% reduction in dose is recommended.

Simultaneous application with sympathomimetics can lead to increased blood pressure and the development of severe headaches.

When used simultaneously with sumatriptan may increase the risk of vasospastic reaction due to additive action.

Bioavailability and maximum concentration in blood plasma of bromocriptine increases with simultaneous application erythromycin, josamycin, clarithromycin, and octreotide.

Bromocriptine increases the concentration of drugs metabolized by the isoenzyme CYP3A4. Care should be taken when using bromocriptine simultaneously with drugs with a narrow therapeutic index, especially those that cause lengthening of the interval QT (eg, amiodarone, imipramine, terbinafine).

Ethanol can lead to the development of disulfiram-like reactions: chest pain, hyperemia, tachycardia, nausea, vomiting, reflex cough, pulsating headache, decreased visual acuity, weakness, convulsions.

Special instructions:

To prevent nausea and / or vomiting at the beginning of treatment, an antagonist of peripheral dopamine receptors, for example, domperidone, for several days, no later than 1 hour before taking bromocriptine.

In the treatment of acromegaly before the appointment of the drug should exclude the presence of gastric ulcer and duodenal ulcer and warn the patient about the need to put the doctor in the knowledge of the occurrence of gastrointestinal disorders.

There are reports of bleeding from the gastrointestinal tract with a lethal outcome when using bromocriptine. There is no evidence that this is due to the use of bromocriptine. Therefore, it is not recommended to apply bromocriptine in patients with erosive-ulcerative lesions of the gastrointestinal tract in the stage of exacerbation.

If gastrointestinal bleeding or stomach ulcers and 12 duodenal ulcers occur, the drug should be discontinued.

Treatment of women with prolactin-dependent dysmenorrhea leads to the normalization of ovulation, therefore, the patient should be warned about the need for contraception (other than oral contraceptives).

Bromocriptine is not recommended for use as a prophylactic or for reducing postpartum engorgement of the mammary glands in cases where the use of antispasmodics, analgesics and wearing comfortable underwear is effective.

Due to the limited amount of clinical data, the drug is not recommended for the treatment of premenstrual syndrome and benign breast diseases.

Patients are recommended to visit the gynecologist on an annual basis; women aged before the onset of menopause - every six months.

In patients receiving bromocriptine, symptomatic arterial hypotension may be observed; in some cases, the appearance of arterial hypotension at the beginning of treatment, especially in the second week of therapy. Daily BP should be monitored, especially during the first weeks of therapy. In the future, blood pressure should be monitored at regular intervals.

In the case of hypertension, the appearance of severe persistent headaches (with or without visual disturbances) or the presence of signs of toxic effects against the central nervous system (CNS), discontinue treatment and conduct a medical examination of the patient.

In some patients with acromegaly with the use of bromocriptine, the development of a "cold" vasospasm was observed. In this case, a dose reduction of bromocriptine is necessary.

With long-term treatment (2-10 years) with high doses of the drug (30 mg per day), it is necessary to closely observe the possible appearance of signs of retroperitoneal fibrosis in patients (eg, back pain, edema of the lower extremities, renal dysfunction), in which it is necessary to stop treatment.

Caution should be exercised in treating patients with Parkinson's disease who may have a mild degree of dementia.

Bromocriptine with monotherapy or in combination with levodopa can cause auditory or visual hallucinations. In most cases, hallucinations can be eliminated by lowering the dose of bromocriptine; sometimes it is required to stop treatment.

Bromocriptine is ineffective in essential and family tremor, as well as in Huntington's chorea.

If bromocriptine treatment is prescribed to women for non-hyperprolactinemia-related pathology, the drug should be used in the minimally effective dose necessary to relieve the symptoms; this is necessary so that the concentration of prolactin in the blood plasma does not decrease below the normal value, since this can cause developmental disorders of the yellow body.

Patients with pituitary macroadenomas should systematically assess the dynamics of tumor size.

Before starting treatment of patients with macroprolactinoma, a complete examination of the pituitary gland function is necessary. In patients with secondary adrenal insufficiency, glucocorticosteroid replacement therapy is of great clinical importance. It is necessary to regularly monitor the size of the pituitary tumor (macrohypophysis adenoma), and in case of an increase in its size, in spite of the therapy, it is necessary to solve the problem of surgical treatment.

Patients who do not want to become pregnant, or if they have large prolactin secreting adenomas of the pituitary gland, should be recommended to use contraceptive measures during treatment with bromocriptine, with the exception of oral contraceptives. In the amenorrhea, a pregnancy test is recommended at least once every 4 weeks, and, when restoring the menstrual cycle, every time the menstruation is delayed. If pregnancy occurs during treatment with a drug in patients with a pituitary tumor, careful monitoring of the patients is necessary.Prolactin-secreting adenomas may increase during pregnancy. In severe cases, it is possible to squeeze the optic or other cranial nerves, which may require emergency surgical intervention.

Visual impairment (loss of visual fields) is a known complication of prolactinoma. Effective treatment with the drug leads to a decrease in the concentration of prolactin in the blood plasma and often there is an improvement in vision. However, in some patients it is possible to develop secondary loss of visual fields, despite the normal concentrations of prolactin in the blood plasma and the reduction in tumor size that can result from the displacement of the optic nerve cross to the Turkish saddle (the formation of a herniated cross of the optic nerves). Therefore, for early diagnosis of secondary loss of the visual field due to a herniated cross of the optic nerves, monitoring of the visual fields in patients with macroprolactinoma for timely correction of the dose of bromocriptine is necessary.

In some patients with prolactin secreting adenomas, rinorrhea of cerebrospinal fluid was observed with bromocriptine.

Careful hygiene of the oral cavity is necessary. If the dryness of the mucous membrane of the oral cavity persists for more than 2 weeks, consult a physician.

The use of bromocriptine can cause drowsiness or episodes of sudden onset of sleep (in particular, in patients with Parkinson's disease) during the day, without any previous symptoms. In such cases, consideration should be given to reducing the dose of the drug.

Application in children and adolescents

The efficacy and safety of bromocriptine have been established in children with prolactinomas and acromegaly over 7 years of age. Given the hard-to-predictable sensitivity of children and adolescents, caution should be exercised when using the drug in this category of patients. The safety and efficacy of bromocriptine in children younger than 7 years is not confirmed.

Use in patients over 65 years of age

The number of patients 65 years of age or older in clinical trials was not sufficient to assess the possible differences in response to bromocriptine compared to younger patients.In clinical trials and medical practice, tolerability of the drug in patients older than 65 years and younger was the same.

Given the difficult predictable tolerability of the drug in patients over 65 years of age, caution should be exercised when using the drug in this category of patients.

Application in the puerperium

Women taking bromocriptine in the postpartum period, rare cases of development of serious adverse events were noted for suppression of lactation, especially at the beginning of treatment: hypertension, myocardial infarction, seizures, stroke or mental disorders.

In some patients, development of seizures or cerebral circulation disorders was preceded by severe headaches and / or transient visual impairment.

Although the causal relationship of the development of these phenomena with the use of bromocriptine is not established, in all patients taking the drug Bromocriptine should monitor BP. With the development of arterial hypertension or severe, progressive or persistent headache (accompanied or not accompanied by a visual impairment) or signs of a violation of the central nervous system, the drug should be discontinued and examined immediately.

In patients with Parkinson's disease using high doses of bromocriptine, it is possible to develop gambling, increased libido and hypersexuality, compulsive shopping and spending money, compulsive overeating. Patients and their relatives should be warned about the possible development of these behavioral control disorders. In case of development of behavioral disorders, it is necessary to reduce the dose of bromocriptine or to cancel its administration.

There is no need for special precautions when destroying an unused preparation.

Effect on the ability to drive transp. cf. and fur:

When taking the drug Bromocriptine should refrain from driving vehicles and activities that require increased attention and speed of physical and psychomotor reactions (possibly sudden falling asleep, reduced visual acuity).

Form release / dosage:

Tablets, 2.5 mg.

Packaging:

For 10, 30 tablets in a contour mesh box made of polyvinylchloride film and aluminum foil printed lacquered.

For 10, 20, 30, 40, 50 or 100 tablets in cans of polymeric polypropylene for medicines, sealed with lids pulled with the control of the first opening of polyethylene.

One jar or 1, 2, 3, 4, 5, 6, 8 or 10 contour squares, together with the instructions for use, are placed in a cardboard package (bundle).

Storage conditions:

In a dry, dark place, at a temperature of no higher than 25 FROM.

Keep out of the reach of children.

Shelf life:

3 years.

Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-000114

Date of registration:28.12.2010 / 16.03.2016

Expiration Date:Unlimited

The owner of the registration certificate:OZONE, LLC OZONE, LLC Russia

Manufacturer: & nbsp

OZONE, LLC Russia

Representation: & nbspOZONE LLC OZONE LLC Russia

Information update date: & nbsp18.04.2017

Illustrated instructions

Instructions

Bromocriptine (Bromocriptine)