Standard and higher doses of bromocriptine for severe chronic portal-systemic encephalopathy

In a single-blind, cross-over fashion we assessed the therapeutic value of the dopamine agonist bromocriptine at doses of 15 and 20 mg/day plus cleansing enemas, versus the vigorous standard treatment of neomycin 6 g/day plus cleansing enemas. We studied four patients with severe chronic portal systemic encephalopathy. All the patients presented elevated prolactin levels. During the study the following parameters were assessed: mental state, number connection test times, frequency of asterixis, EEG, blood ammonia, and serum prolactin levels. In all but one patient, portal systemic encephalopathy parameters improved during the standard therapy, as opposed to both bromocriptine periods. During the period with 30 mg/day of bromocriptine all four patients developed precoma, although later one patient improved. Serum prolactin levels were rapidly suppressed during both bromocriptine periods. Prolactin levels did not correlate with changes in mental state. In patients with severe portal systemic encephalopathy, treatments with 15 and 30 mg of bromocriptine plus cleansing enemas were no better than the standard therapy.