Medication-Induced Hyperprolactinemia

Abstract

Medication use is a common cause of hyperprolactinemia, and it is important to differentiate this cause from pathologic causes, such as prolactinomas. To ascertain the frequency of this clinical problem and to develop treatment guidelines, the medical literature was searched by using PubMed and the reference lists of other articles dealing with hyperprolactinemia due to specific types of medications. The medications that most commonly cause hyperprolactinemia are antipsychotic agents; however, some newer atypical antipsychotics do not cause this condition. Other classes of medications that cause hyperprolactinemia include antidepressants, antihypertensive agents, and drugs that increase bowel motility. Hyperprolactinemia caused by medications is commonly symptomatic, causing galactorrhea, menstrual disturbance, and impotence. It is Important to ensure that hyperprolactinemia in an Individual patient is due to medication and not to a structural lesion in the hypothalamic/pituitary area; this can be accomplished by (1) stopping the medication temporarily to determine whether prolactin levels return to normal, (2) switching to a medication that does not cause hyperprolactinemia (in consultation with the patient's psychiatrist for psychoactive medications), or (3) performing magnetic resonance imaging or computed tomography of the hypothalamic/pituitary area. If the patient's hyperprolactinemia is symptomatic, treatment strategies include switching to an alternative medication that does not cause hyperprolactinemia, using estrogen or testosterone replacement, or, rarely, cautiously adding a dopamine agonist.

New concepts in prolactin biology

“…) are very efficient drugs to treat hyperprolactinemic patients presenting with prolactinoma (Molitch 2005a). However, as described above, such compounds are per se inappropriate to target locally produced PRL (whose expression is dopamine independent) or constitutively active receptors (whose basal activity is independent of PRL).…”

“…This is in agreement with the fact that their mechanism of action involves blockade of dopamine D2 receptors. Dopamine agonist therapy is usually not advisable for treating associated symptomatic hyperprolactinemia, although this approach has been used successfully in some instances (Molitch 2005a).…”

The Possible Role of Fluoxetine in Adenomyosis: An Animal Experiment with Clinical Correlations

“…Exposure of the murine uterus to an increased PRL, appears to be sufficient to cause histologic adenomyosis [8]. The expression of the uterine PRL receptor messenger RNA is also up-regulated in that model [7].…”

National consensus on the management of patients with hyperprolactinemia (2016)

“…Нейролептики/ антипсихотичні препарати можуть викликати ГП у 40-90% пацієнтів у зв'язку з антагоністичним ефектом дофаміну на такий тип ліків [26]. Верапаміл є причиною ГП у 8,5% пацієн-тів, а в жінок, що застосовують комбіновані оральні контра-цептиви, можуть виявитися злегка підвищені рівні сироват-кового пролактину -від 12 до 30% випадків [27,28].…”