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•Prescrire International Special Edition 2015/Volume 24 N°158
A
In a survey of women not wishing
to breastfeed, conducted in a French
maternity hospital, 89% of those who
received balanced information chose
not to take
bromocriptine
to prevent
puerperal lactation.
R
ye-ergot-derived dopamine agonists
such as bromocriptine are proposed
to prevent puerperal lactation but can
have serious cardiovascular effects,
sometimes at the very outset of treat-
ment, including arterial hypertension,
myocardial infarction, stroke, hallucina-
tions and convulsions (1). This is why
the use of dopamine agonists to prevent
puerperal lactation is prohibited in the
United States for example (1).
Informing women.
A French team
conducted a prospective study of
61 women with a mean age of 30 years
(2). They were hospitalised in three
maternity units of a Toulouse hospital
and had chosen not to breastfeed their
babies. Half of them received a leaflet
explaining both the benefits and dangers
of bromocriptine, as well as alternatives
for relieving pain and discomfort associ-
ated with puerperal lactation. The other
patients received advice from midwives.
The endpoints included drugs prescribed
and taken, pain intensity, and overall
patient satisfaction.
Less bromocriptine use.
Thirty-one
of the women had already had at least
one child. Among the 22 women who
said they had chosen not to breastfeed
their other children, 13 (59%) recalled
receiving bromocriptine.
During the study 51 women (84%)
chose to use a homeopathic medicine
after childbirth, while 7 (11%) opted for
bromocriptine and 2 (3%) chose not to
take any medication. One patient who
chose homeopathic medicine subse-
quently asked to receive bromocrip-
tine because her pain was too intense.
Almost all the women felt the need to
take analgesics during puerperal lacta-
tion, consisting of paracetamol plus ibu-
profen (53%), paracetamol alone (41%)
or ibuprofen alone (1.6%). 4.9% of the
women did not take analgesics.
Most women satisfied.
Most of the
patients (87%) said they were satisfied
with their choice.
The women who chose to take bro-
mocriptine said they did so because they
had taken it during a previous pregnancy
or because their doctor recommended it.
In practice.
This study shows that,
after receiving balanced information on
the harms and benefits of using bro-
mocriptine to prevent puerperal lacta-
tion, many women choose not to use
bromocriptine and that most of them are
satisfied with their choice.
©Prescrire
Selected references from Prescrire’s literature
search.
1-
Prescrire Editorial Staff “Do not use drugs to
prevent onset of lactation . Relieve the discomfort
and wait”
Prescrire Int
2013;
22
(140): 186-188.
2-
Fresnay E “Optimisation de la prescription de
bromocriptine en suites de couches” Thèse phar-
macie n° 2009, Toulouse, 2008.
Translated from
Rev Prescrire
November 2014; 34 (373): 830
Pregabalin: major weight gain
Pregabalin
can increase body
weight by up to 20 kg.
T
he Saint-Etienne Regional Phar-
macovigilance Centre in France
analysed cases of weight gain attribu-
ted to pregabalin that were recorded in
the French pharmacovigilance database
between 1 January 2006 and 30 Novem-
ber 2013 (1).
Pregabalin, an analogue of gamma-
amino butyric acid (GABA), is used in
partial epilepsy, neuropathic pain and
generalised anxiety disorder (2). It can
cause weight gain through increased
appetite and oedema (3).
Pregabalin was the only drug sus-
pected of causing weight gain in 47 of
58 reports, 16 of which could be ana-
lysed in detail. These 16 reports included
13 women and 3 men, with an average
age of 63 years, who took pregabalin at
daily doses of 25 mg to 600 mg, mainly
for neuropathic pain (13 patients) (1).
Their body weight increased by an
average of nearly 8 kg (up to 20 kg) after
an average of 3.5 months of treatment
(range 5 days to 9 months) (1). Oedema
was associated with the weight gain in 8
of the 16 patients. More than two-thirds
of patients lost weight when they stopped
taking pregabalin (8 patients: average
weight loss 5.3 kg, range 2 kg to 15.6 kg),
when the dose was reduced (2 patients),
or after an unspecified treatment modifi-
cation (1 patient). Three other patients
did not lose weight despite pregabalin
withdrawal or dose reduction. The two
patients whose treatment was not modi-
fied did not lose weight.
In clinical trials of pregabalin, about
6% of patients gained weight (average
1.6 kg), versus about 1% of patients
on placebo (average 0.3 kg) (3). These
average weight gains may seem small,
but they mask the fact that some patients
treated with pregabalin put on a great
deal of weight.
In practice.
Weight gain is a known
adverse effect of pregabalin, and it is
sometimes rapid and massive. Patients
must be informed of this reaction and
should be prescribed a lower dose or
taken off pregabalin altogether, in case
of major weight gain.
©Prescrire
Selected references from Prescrire’s literature
search.
1-
George K et al. “Pregabalin and weight gain:
analysis of French Pharmacovigilance data-
base” 35
th
Pharmacovigilance Meeting, Poitiers:
22-24 April 2014.
Fundamental Clin Pharmacol
2014;
28
(suppl.1): 48-49 (abstract PM1-088)
(full text: 1 page).
2-
Prescrire Rédaction “Prégabaline: antiépilep-
tique analogue du GABA sous forme buvable”
Rev
Prescrire
2014;
34
(368): 426.
3-
Prescrire Editorial Staff “Drug-induced weight
gain”
Prescrire Int
2012;
21
(123): 11-14.
Translated from
Rev Prescrire
September 2014; 34 (371): 667
Choosing not to take bromocriptine
Prescrire Int • February 2015
Prescrire Int • February 2015
