Bromocriptine in Peripartum Cardiomyopathy: Evidence, Controversy and Practical Use

Background Peripartum cardiomyopathy is a potentially life threatening form of heart failure that develops mainly towards the end of pregnancy or during the months following delivery, pregnancy termination, or miscarriage. Cleavage of full length prolactin into an antiangiogenic 16 kDa fragment is one proposed mechanism of myocardial injury and provides the rationale for prolactin suppression with bromocriptine. However, the clinical efficacy and safety of bromocriptine remain uncertain, and European and United States recommendations differ. Aim To critically evaluate current evidence concerning the efficacy, safety, and practical use of bromocriptine in peripartum cardiomyopathy. Materials and methods A narrative review of English language publications issued from January 2000 through June 2026 was conducted using PubMed, the Cochrane Library, and Google Scholar. The final literature search was conducted in June 2026. Eligible sources included preclinical studies, clinical trials, observational studies, registries, systematic reviews, meta analyses, narrative reviews, clinical guidelines, position statements, and relevant editorials. A total of 44 sources were included in the narrative synthesis. Results Available clinical evidence suggests that bromocriptine may improve left ventricular ejection fraction, although benefits for major clinical outcomes remain uncertain. In the EORP PPCM Registry, the composite outcome occurred in 22% of patients receiving bromocriptine and 33% receiving standard care (p = 0.044). The association remained significant after adjustment (OR 0.47, 95% CI 0.31 to 0.70; p < 0.001), while thromboembolic event rates were similar. Small trials, treatment heterogeneity, and observational data preclude causal conclusions. European guidelines state that bromocriptine may be considered, whereas the United States guideline assigns no formal recommendation class. Conclusions Bromocriptine may be considered as an adjunct to standard heart failure therapy in selected women with peripartum cardiomyopathy, but its effects on major clinical outcomes remain uncertain. When bromocriptine is used, concomitant anticoagulation at a minimum prophylactic dose should be considered according to applicable recommendations and individual thromboembolic and bleeding risks. The consequences of lactation suppression should be discussed with the patient. Further adequately powered randomized trials are required to determine clinical efficacy, safety, optimal treatment duration, and appropriate patient selection.