Better living through chemistry
Cycloset (generic name = bromocriptine mesylate) was just approved for treatment of type 2 diabetes by the U.S. Food and Drug Administration. It’s a completely new approach that increases dopamine activity in the brain. This review is quite limited—consult your physician or pharmacist for full details. Remember that drug names vary by country and manufacturer.
Dopamine receptor agonist.
How Does It Work?
How it lowers glucose levels is not entirely clear, but it may reset or alter glucose metabolism in tissues outside the brain. Bromocriptine is an ergot derivative that increases dopamine activity in the brain. Cycloset improves after-meal glucoses without an increase in blood insulin levels. This is appealing since high insulin levels are implicated as a contributor to some chronic diseases.
It’s for adults with type 2 diabetes and can be used alone or with certain other diabetes drugs. “Other drugs” used in clinical trials were mostly metformin and sulfonylureas, with less experience using it with thiazolidinediones. We know little about using it with insulin. Bromocriptine is not for type 1 diabetics or diabetic ketoacidosis. It lowers hemoglobin A1c by 0.6 to 0.9% (absolute decrease).
Start with 0.8 mg every morning and increase by an additional tablet (0.8 mg) weekly up to 4.8 mg or the maximal tolerated dose (1.6 to 4.8 mg). Take all of it in the morning.
In clinical studies, the most common cause for discontinuation of the drug was nausea. It can cause drowsiness, fainting, blood pressure drops with standing (causing lightheadedness, fainting, weakness, or sweating), fatigue, vomiting, and headaches. Hypoglycemia is not much of a problem, if any, when bromocriptine is used as the sole diabetic medication. In other words, bromocriptine by itself may slightly increase the risk of hypoglycemia.
Bromocriptine has been in use for many years to treat other conditions, so we may not see any of the unforeseen consequences that have led to so many drugs being pulled from the market a couple years after FDA approval.
Don’t Use It If You . . .
-take neuroleptic drugs, are a nursing mother, have syncopal migraines (that make you faint), have hypersensitivity to ergot-related drugs, or have a severe psychotic disorder.
If you gotta have type 2 diabetes, this is a great time in history to have it. Twenty five years ago, we had maybe three classes of medications to fight it. By my count, we’re up to 11 classes now. Always good to have options!
Steve Parker, M.D.
Reference: VeroScience Announces FDA Approval of Cyclocet for Treatment of Type 2 Diabetes, in Medical News Today, May 7, 2009.
Cycloset Package Insert
Date last modified: December 2, 2010