THE ONCE-DAILY DOSE OF CYCLOSET, TAKEN IN THE MORNING, WITHIN 2 HOURS OF WAKING, WITH FOOD, REDUCED POSTPRANDIAL GLUCOSE AT 2 HOURS AFTER EACH MEAL, WITHOUT RAISING PLASMA INSULIN LEVELS.1
DIURNAL POSTPRANDIAL PLASMA GLUCOSE LEVEL CHANGE FROM BASELINE TO WEEK 24 (STUDY END),
DIFFERENCE FROM PLACEBO AT 1 AND 2 HOURS (PHARMACODYNAMIC DATA)2,a
aStudy Design: Subjects with type 2 diabetes on diet therapy alone and in poor glycemic control were randomized to treatment with CYCLOSET or placebo (baseline fasting plasma glucose: 214 ± 6 and 203 ± 6 mg/dL, and HbA1c: 9.0 ± 0.1 and 8.8 ± 0.1, respectively) and administered standardized meals at breakfast, lunch, and dinner, before and 24 weeks following treatment. Plasma samples taken before and 1 and 2 hours after each meal were analyzed for glucose and insulin.2
A two-way repeated measures (ANOVA) analysis of treatment and hour indicate a significant treatment effect over the entire diurnal (7 AM to 7 PM) period (P=0.0012). The change from baseline in 2-hour glucose level is significantly different for CYCLOSET vs. placebo at all three meals (P<0.05). The CYCLOSET-induced improvements on diurnal and postprandial glucose were not associated with an increase in insulin level measured at any of these test times.2
INDICATION
CYCLOSET® (bromocriptine mesylate) 0.8 mg tablets is a dopamine receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
LIMITATIONS OF USE
CYCLOSET should not be used to treat type 1 diabetes or diabetic ketoacidosis.
Limited efficacy data in combination with thiazolidinediones.
Efficacy has not been confirmed in combination with insulin.
IMPORTANT SAFETY INFORMATION
Contraindications
CYCLOSET is contraindicated in:
Patients with hypersensitivity to ergot-related drugs, bromocriptine or to any of the excipients in CYCLOSET.
Patients with syncopal migraines. May precipitate hypotension.
Postpartum patients. Serious and life-threatening adverse reactions have been reported.
Lactating patients. CYCLOSET contains bromocriptine which inhibits lactation.
Orthostatic Hypotension/Syncope
CYCLOSET can cause orthostatic hypotension and syncope, particularly upon initiation or dose escalation. Use caution in patients taking antihypertensive medications. Orthostatic vital signs should be assessed prior to initiation of CYCLOSET and periodically thereafter.
Advise patients during early treatment to avoid situations that could lead to injury if syncope were to occur, and to make slow postural changes.
Psychotic Disorders
The use of CYCLOSET in patients with severe psychotic disorders is not recommended.
Impulse Control/Compulsive Behaviors
Consider dose reduction or discontinuation of CYCLOSET if a patient develops intense urges to gamble, increased sexual urges, intense urges to spend money uncontrollably and/or other intense urges.
Somnolence
CYCLOSET may cause somnolence, particularly when initiating therapy. Advise patients not to drive or operate heavy machinery if symptoms of somnolence occur.
Concomitant Use of Dopamine Antagonists or Agonists
Concomitant use with dopamine antagonists, such as neuroleptic agents, may diminish the effectiveness of both drugs and is not recommended.
Effectiveness and safety are unknown in patients already taking dopamine receptor agonists for other indications and concomitant use is not recommended.
Risks in Postpartum Patients
CYCLOSET is contraindicated in postpartum patients. Serious and life-threatening adverse reactions have been reported in postpartum women who were administered bromocriptine for inhibition of lactation. These risks may be higher in postpartum patients with cardiovascular disease. The indication for use of bromocriptine for inhibition of postpartum lactation was withdrawn from bromocriptine-containing products and is not approved for CYCLOSET.
Safety and Effectiveness in Pediatrics
The safety and effectiveness of CYCLOSET in pediatric patients have not been established.
Adverse Reactions
In clinical trials, the most common adverse reactions reported in ≥5% of patients treated with CYCLOSET, and reported more commonly than in patients treated with placebo, included nausea, fatigue, dizziness, vomiting, and headache. Postmarketing reports with higher doses of bromocriptine used for other indications include psychotic disorders, hallucinations, and fibrotic complications.
Drug Interactions
May increase the unbound fraction of highly protein-bound therapies, altering their effectiveness and safety profiles.
May increase ergot-related side effects or reduce ergot effectiveness for migraines if co-administered within 6 hours of ergot-related drugs.
Extensively metabolized by CYP3A4. Limit CYCLOSET dose to 1.6 mg/day during concomitant use of moderate CYP3A4 inhibitors. Avoid concomitant use of CYCLOSET with strong CYP3A4 inhibitors.
To report SUSPECTED ADVERSE REACTIONS, contact Salix Pharmaceuticals at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Please click here for full Prescribing Information for CYCLOSET.
References: 1. CYCLOSET [prescribing information]. Tiverton, RI: VeroScience LLC; 2020. 2. Data on file, Salix Pharmaceuticals.
INDICATION
CYCLOSET® (bromocriptine mesylate) 0.8 mg tablets is a dopamine receptor agonist indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
LIMITATIONS OF USE
CYCLOSET should not be used to treat type 1 diabetes or diabetic ketoacidosis.
Limited efficacy data in combination with thiazolidinediones.
Efficacy has not been confirmed in combination with insulin.
IMPORTANT SAFETY INFORMATION
Contraindications
CYCLOSET is contraindicated in:
Patients with hypersensitivity to ergot-related drugs, bromocriptine or to any of the excipients in CYCLOSET.
Patients with syncopal migraines. May precipitate hypotension.
Postpartum patients. Serious and life-threatening adverse reactions have been reported.
Lactating patients. CYCLOSET contains bromocriptine which inhibits lactation.
Orthostatic Hypotension/Syncope
CYCLOSET can cause orthostatic hypotension and syncope, particularly upon initiation or dose escalation. Use caution in patients taking antihypertensive medications. Orthostatic vital signs should be assessed prior to initiation of CYCLOSET and periodically thereafter.
Advise patients during early treatment to avoid situations that could lead to injury if syncope were to occur, and to make slow postural changes.
Psychotic Disorders
The use of CYCLOSET in patients with severe psychotic disorders is not recommended.
Impulse Control/Compulsive Behaviors
Consider dose reduction or discontinuation of CYCLOSET if a patient develops intense urges to gamble, increased sexual urges, intense urges to spend money uncontrollably and/or other intense urges.
Somnolence
CYCLOSET may cause somnolence, particularly when initiating therapy. Advise patients not to drive or operate heavy machinery if symptoms of somnolence occur.
Concomitant Use of Dopamine Antagonists or Agonists
Concomitant use with dopamine antagonists, such as neuroleptic agents, may diminish the effectiveness of both drugs and is not recommended.
Effectiveness and safety are unknown in patients already taking dopamine receptor agonists for other indications and concomitant use is not recommended.
Risks in Postpartum Patients
CYCLOSET is contraindicated in postpartum patients. Serious and life-threatening adverse reactions have been reported in postpartum women who were administered bromocriptine for inhibition of lactation. These risks may be higher in postpartum patients with cardiovascular disease. The indication for use of bromocriptine for inhibition of postpartum lactation was withdrawn from bromocriptine-containing products and is not approved for CYCLOSET.
Safety and Effectiveness in Pediatrics
The safety and effectiveness of CYCLOSET in pediatric patients have not been established.
Adverse Reactions
In clinical trials, the most common adverse reactions reported in ≥5% of patients treated with CYCLOSET, and reported more commonly than in patients treated with placebo, included nausea, fatigue, dizziness, vomiting, and headache. Postmarketing reports with higher doses of bromocriptine used for other indications include psychotic disorders, hallucinations, and fibrotic complications.
Drug Interactions
May increase the unbound fraction of highly protein-bound therapies, altering their effectiveness and safety profiles.
May increase ergot-related side effects or reduce ergot effectiveness for migraines if co-administered within 6 hours of ergot-related drugs.
Extensively metabolized by CYP3A4. Limit CYCLOSET dose to 1.6 mg/day during concomitant use of moderate CYP3A4 inhibitors. Avoid concomitant use of CYCLOSET with strong CYP3A4 inhibitors.
To report SUSPECTED ADVERSE REACTIONS, contact Salix Pharmaceuticals at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Please click here for full Prescribing Information for CYCLOSET.