How can prolactin levels be increased in a patient?

From the Guidelines

Prolactin levels can be increased through the use of dopamine antagonists, such as metoclopramide, domperidone, or antipsychotics like risperidone, which block dopamine's inhibitory effect on prolactin secretion. These medications are the most reliable method for increasing prolactin levels. Other options include certain antidepressants, particularly selective serotonin reuptake inhibitors like sertraline, which can also increase prolactin levels 1. Non-pharmacological methods, such as regular breast stimulation through nursing, pumping, or manual stimulation, may also help increase prolactin levels. Additionally, stress reduction techniques and adequate sleep are important, as chronic stress can suppress prolactin and prolactin secretion peaks during sleep. Some herbs like fenugreek and blessed thistle may stimulate prolactin production, though evidence is limited 1.

When considering increasing prolactin levels, it is essential to prioritize the patient's overall health and well-being, taking into account potential side effects of hyperprolactinemia, such as menstrual irregularities, decreased libido, and galactorrhea. Medical supervision is crucial when attempting to increase prolactin levels. The most recent and highest quality study, published in 2024 in Nature Reviews Endocrinology, provides guidance on the management of pituitary adenomas in childhood and adolescence, including the use of dopamine agonists and other treatments for prolactinoma 1.

Key points to consider when increasing prolactin levels include:

• Using dopamine antagonists, such as metoclopramide or domperidone, to block dopamine's inhibitory effect on prolactin secretion
• Considering the use of certain antidepressants, such as selective serotonin reuptake inhibitors, to increase prolactin levels
• Implementing non-pharmacological methods, such as regular breast stimulation and stress reduction techniques, to support prolactin production
• Monitoring for potential side effects of hyperprolactinemia and prioritizing the patient's overall health and well-being.

From the FDA Drug Label

Metoclopramide elevates prolactin levels and the elevation persists during chronic administration. Metoclopramide induces release of prolactin

Increasing Prolactin Levels: Metoclopramide can be used to increase prolactin levels in a patient, as it has been shown to elevate prolactin levels and this elevation persists during chronic administration 2.

• Key Points:
  • Metoclopramide induces the release of prolactin.
  • The elevation of prolactin levels persists during chronic administration of metoclopramide.
• Important Consideration: The clinical significance of elevated serum prolactin levels is unknown for most patients, and the use of metoclopramide should be cautiously considered, especially in patients with previously detected breast cancer 2.

From the Research

Increasing Prolactin Levels

To increase prolactin levels in a patient, several factors and medications can be considered:

• Certain medications can cause an increase in prolactin levels, such as antipsychotic agents, antidepressants, antihypertensive agents, and drugs that increase bowel motility 3.
• Dopamine receptor antagonists, such as classic and atypical antipsychotic drugs, can also stimulate prolactin secretion 4.
• Other prolactin-stimulating agents include drugs that enhance serotoninergic neurotransmission, blockers of serotonin reuptake, and H1-receptor agonists 4.
• Estrogens, thyroid-releasing factor, vasoactive intestinal peptides, opioids, surgery, illness, and psychic or physical stress can also increase prolactin secretion 5.

Medications that Increase Prolactin Levels

Some specific medications that can increase prolactin levels include:

• Antipsychotic agents, such as risperidone (> 6 mg/day) 5.
• Dopamine receptor antagonists, such as haloperidol and chlorpromazine 4.
• Certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) 3.
• Antihypertensive agents, such as verapamil and diltiazem 3.

Important Considerations

It is essential to note that increasing prolactin levels can have various effects on the body, including:

• Galactorrhea (spontaneous flow of milk from the breast) 3, 6.
• Menstrual disturbances, such as amenorrhea (absence of menstruation) 3, 6.
• Erectile dysfunction in men 3.
• Loss of libido in both men and women 5.
• Increased risk of osteoporosis in women 5.