Tweet
Benzodiazepines
Buspirone
MAOIs, SSRIs, TCAs
Butyrophenones (e.g. haloperidol)
Phenothiazines (e.g. thorazine)
Thioxanthenes (e.g. thiothixene)
Sumatriptan (Imitrex)
Valproic acid (Depakote, Depakene)
Dihydroergotamine (DHE 45)
Methyldopa (Aldomet)
Reserpine
Verapamil
Atenolol
Metoclopramine (Reglan)
Danazol
Estrogen
Medroxyprogesterone acetate
Oral contraceptives
Cimetidine (Tagamet)
Famotidine (Pepcid)
Ranitidine (Zantac)
Amphetamines
Marijuana
Opiates
Anise
Blessed Thistle
Fennel
Marshmallow
Nettle
Red Clover
Red Raspberry
Some of these drugs target the dopamine D2 receptor. By attaching to this receptor, these drugs elevate serum prolactin. Newer atypical antipsychotics are thought to avoid this adverse effect due to their varied receptor binding profiles. In a recent study conducted by Turrone et al and reported in the American Journal of Psychiatry (Jan 2002;159:133-5), it was determined that atypical antipsychotics do elevate prolactin levels in a dose related fashion. Increases in prolactin levels with atypical antipsychotics are most pronounced in the 1-5 hour period after medication administration and return to baseline values by 12 to 24 hours, thus masking the drug’s acute effect on prolactin. Risperidone (Risperdal) is the exception. Patients taking this drug experienced ongoing elevations of prolactin similar to traditional antipsychotics.javascript:newshowcontent(‘active’, 'references’);
Hyperprolactinemia
Symptoms
In women
Treatment
Dopamine agonists have become the treatment of choice for the majority of patients with hyperprolactinemic disorders although these drugs are not without some serious side effects. These dopamine agonists are bromocriptine, cabergoline and quinagolide. Dopamine agonist treatment may not be required indefinitely.
Estrogen therapy in the form of hormone replacement therapy or an oral contraceptive may be offered as an alternative to dopamine agonist therapy to women with IH or microprolactinoma who do not want to become pregnant and in whom estrogen deficiency is the major concern, particularly in those who are resistant to or intolerant of dopamine agonists. Patients receiving estrogens rather than a dopamine agonist should be monitored for symptoms or signs of tumor expansion, and therapy discontinued if there is radiological evidence of tumor enlargement.
Transsphenoidal surgery was the preferred therapy for prolactinomas before the availability of dopamine agonists in the early 1970s. Since then, surgery has gradually been used less frequently as the primary therapy and is now usually reserved for patients who are unresponsive to or intolerant of preferred medication therapy and for those rare patients who develop symptoms of mass effect despite treatment.Although dopamine agonists have the advantage of being a noninvasive treatment, transsphenoidal surgery offers the possibility of achieving complete cure in selected patients, although at the expense of significant risk in terms of morbidity, especially hypopituitarism, and a very low mortality rate.
Buspirone
MAOIs, SSRIs, TCAs
Butyrophenones (e.g. haloperidol)
Phenothiazines (e.g. thorazine)
Thioxanthenes (e.g. thiothixene)
Sumatriptan (Imitrex)
Valproic acid (Depakote, Depakene)
Dihydroergotamine (DHE 45)
Methyldopa (Aldomet)
Reserpine
Verapamil
Atenolol
Metoclopramine (Reglan)
Danazol
Estrogen
Medroxyprogesterone acetate
Oral contraceptives
Cimetidine (Tagamet)
Famotidine (Pepcid)
Ranitidine (Zantac)
Amphetamines
Marijuana
Opiates
Anise
Blessed Thistle
Fennel
Marshmallow
Nettle
Red Clover
Red Raspberry
Some of these drugs target the dopamine D2 receptor. By attaching to this receptor, these drugs elevate serum prolactin. Newer atypical antipsychotics are thought to avoid this adverse effect due to their varied receptor binding profiles. In a recent study conducted by Turrone et al and reported in the American Journal of Psychiatry (Jan 2002;159:133-5), it was determined that atypical antipsychotics do elevate prolactin levels in a dose related fashion. Increases in prolactin levels with atypical antipsychotics are most pronounced in the 1-5 hour period after medication administration and return to baseline values by 12 to 24 hours, thus masking the drug’s acute effect on prolactin. Risperidone (Risperdal) is the exception. Patients taking this drug experienced ongoing elevations of prolactin similar to traditional antipsychotics.javascript:newshowcontent(‘active’, 'references’);
Hyperprolactinemia
Symptoms
In women
- Hypogonadism
- Nipple tenderness
- Nipple discharge
- Changes in nipple shape and appearance
- infrequent menstruation
- Loss of menstruation
- Heavy menstruation
- Infertility
- Decreased libido
- Habitual abortion
- Osteopenia – resulting from low estrogen
- Hirsutism – due to hyperandrogenism
- Acne – due to hyperandrogenism
- Infertility – due to low sperm production
- Nipple tenderness
- Nipple discharge
- Changes in nipple shape and appearance
- Enlarged breast
- Decreased libido
- Decreased potency
- Reduced muscle mass
- Osteopenia
Treatment
Dopamine agonists have become the treatment of choice for the majority of patients with hyperprolactinemic disorders although these drugs are not without some serious side effects. These dopamine agonists are bromocriptine, cabergoline and quinagolide. Dopamine agonist treatment may not be required indefinitely.
Estrogen therapy in the form of hormone replacement therapy or an oral contraceptive may be offered as an alternative to dopamine agonist therapy to women with IH or microprolactinoma who do not want to become pregnant and in whom estrogen deficiency is the major concern, particularly in those who are resistant to or intolerant of dopamine agonists. Patients receiving estrogens rather than a dopamine agonist should be monitored for symptoms or signs of tumor expansion, and therapy discontinued if there is radiological evidence of tumor enlargement.
Transsphenoidal surgery was the preferred therapy for prolactinomas before the availability of dopamine agonists in the early 1970s. Since then, surgery has gradually been used less frequently as the primary therapy and is now usually reserved for patients who are unresponsive to or intolerant of preferred medication therapy and for those rare patients who develop symptoms of mass effect despite treatment.Although dopamine agonists have the advantage of being a noninvasive treatment, transsphenoidal surgery offers the possibility of achieving complete cure in selected patients, although at the expense of significant risk in terms of morbidity, especially hypopituitarism, and a very low mortality rate.
Comment