In all patients treated with bromocriptine, prolactin levels fall to normal. Pituitary tumour size decreases in about fifty per cent of cases, particularly those with mixed GH and prolactin-secreting tumours in whom, because of this effect, bromocriptine should probably be used first. Although, in most patients, the response of the GH level to octreotide is better than to bromocriptine, there are occasional acromegalic patients who respond better to bromocriptine. Bromocriptine may be administered orally, but side effects include postural hypotension, nausea and vomiting. These may be avoided by starting with a low dose (e.g. 1.25mg per day), increasing the dosage slowly (i.e. every three days) and advising patients to take the drug during meals.
