Bromocriptine in the treatment of chronic hepatic encephalopathy refractory to conventional treatment: crossover trial with levodopa benserazide

A crossover clinical comparison of bromocriptine and levodopa benserazide, two dopamine-active drugs, during a stable course of conventional therapy (protein restriction, lactulose, supportive parenteral feeding) was performed in 5 non-alcoholic cirrhotic patients with severe long-standing chronic portal systemic encephalopathy. Patients responded poorly to a previous course of conventional therapy. All patients showed a significant overall improvement while on bromocriptine and levodopa-benserazide in comparison with conventional therapy alone. Even if a significant progressive decrease of arterial ammonia was observed throughout the study, neurological improvment could not be related to reduction of hyperammonemia: crossover to conventional therapy alone, withdrawing bromocriptine or levodopa-benserazide, produced a marked worsening in clinical state. In all patients, symptomatic hypotension induced withdrawal of bromocriptine after 4 to 8 days of treatment, at a mean dose of 5 mg/day, before completing the protocol period. A slightly better response in neurological conditions (mental state, asterixis, sleep rhythm disturbances) was observed during the levodopa-benserazide treatment period in comparison with the bromocriptine treatment period. Bromocriptine seems effective in the symptomatic treatment of hepatic encephalopathy. It can be used in cases needng a rapid central dopamine-stimulating effect, provided that a close monitoring of circulatory conditions can be available.