Bromocriptine for Central Hyperthermia after Acute Brain Injury: A Retrospective Cohort Study

Introduction Bromocriptine is a dopamine receptor agonist used in clinical practice for central hyperthermia with limited published data. We sought to describe the patient population treated with bromocriptine for central hyperthermia and report the most common dosing regimens, efficacy, and reasons for discontinuation of therapy. Methods This was a retrospective cohort study conducted at a single academic Level 1 Trauma Center and advanced comprehensive stroke center. Patients were 18 years and older, admitted to the neurocritical or surgical/trauma intensive care units for acute neurological emergencies, and were administered bromocriptine to manage central fevers between April 2016 and September 2022. Baseline characteristics, disease severity markers, and bromocriptine doses during ICU admission were collected. The highest body temperature in the 8 hours prior to the first dose of bromocriptine as well as at the time of dose and every hour for up to 6 hours after each dose were recorded. Hyperthermia was defined as a recorded temperature of ≥ 38.3°C. Potential bromocriptine responsiveness was defined as resolution of hyperthermia at 1- or 2-hours post-bromocriptine administration. Coadministration of additional therapies for fever management or paroxysmal sympathetic hyperactivity (PSH) and confounding therapies were noted. Results 30 patients were included with a mean age of 45 (± 17.3) years. Patients were 70% male and 67% Caucasian. The most common diagnosis was TBI (N = 14) followed by SAH (N = 6), and median admission GCS was 5.5 (IQR 3.0-10.8). Median cumulative daily dose was 8mg (IQR 5–15, range 2.5–60). There was a paired mean difference of -0.37°C (p = 0.005) between the average temperature prior to bromocriptine initiation and after initiation. Potential responsiveness was observed after 41% of doses at 1 hour and 62% of doses at 2 hours. All patients received at least one other therapy for management of fevers or PSH and at least one potentially confounding therapy. The most common reason for discontinuation was resolution of indication (N = 14). Discontinuation due to mild adverse effects occurred in 4 patients. Conclusion Bromocriptine is a potential therapy for management of central hyperthermia in patients with acute neurologic emergencies for severely critically ill patients who have failed other therapies. There was a small but statistically significant decrease in average temperature pre- and post-administration of bromocriptine. Results may have been confounded by administration of additional medications and other antipyretics.