From the FDA Drug Label
Adverse reactions reported since market introduction that were temporally related to duloxetine delayed-release capsules therapy and not mentioned elsewhere in labeling include: ... hyperprolactinemia, ...
- Hyperprolactinemia has been reported as an adverse reaction in the postmarketing experience with duloxetine delayed-release capsules 1.
- This suggests that duloxetine may cause hyperprolactinemia in some cases.
From the Research
Duloxetine can occasionally cause hyperprolactinemia, as evidenced by a case report published in 2020 2, but it is not a common side effect. Hyperprolactinemia occurs more frequently with antipsychotics and some other antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that affects serotonin levels, which can indirectly influence prolactin secretion. The mechanism involves serotonin's stimulation of prolactin release through inhibition of dopamine, which normally suppresses prolactin. Some key points to consider:
- If a patient on duloxetine develops symptoms such as galactorrhea (spontaneous milk discharge), menstrual irregularities in women, decreased libido, or erectile dysfunction in men, checking prolactin levels would be appropriate.
- Most cases of medication-induced hyperprolactinemia resolve when the medication is discontinued or the dose is reduced, as seen in a case report where prolactin levels returned to normal after a month of drug-free period and cabergoline treatment 2.
- However, patients should not stop taking duloxetine abruptly without medical supervision, as this can cause withdrawal symptoms.
- If hyperprolactinemia is suspected while on duloxetine, consultation with a healthcare provider is necessary to evaluate the condition and consider alternative treatment options if needed, such as adjunctive aripiprazole, which has been suggested as a potential treatment option for duloxetine-induced hyperprolactinemia 3. It's also worth noting that the prevalence of hyperprolactinemia under antidepressants, including duloxetine, is very low compared to antipsychotics, particularly of the first generation, as stated in a 2022 review 4.