From the Guidelines
Prolactin levels are increased by various factors, including medications, physiological conditions, and certain diseases, with the most significant elevations often associated with pituitary tumors, hypothyroidism, and certain medications such as antipsychotics and dopamine antagonists 1.
Causes of Elevated Prolactin
- Medications: antipsychotics (e.g., risperidone, haloperidol, olanzapine), certain antidepressants (e.g., SSRIs), metoclopramide, domperidone, verapamil, and estrogens
- Physiological conditions: pregnancy, breastfeeding, sleep, stress, and nipple stimulation
- Medical conditions: pituitary tumors (prolactinomas), hypothyroidism, chronic kidney disease, liver cirrhosis, and chest wall injuries or surgeries
- Hypothalamic disorders affecting dopamine, which normally inhibits prolactin
Importance of Identifying Causes
Understanding the causes of hyperprolactinemia is crucial because it can impact fertility and bone health if left untreated, and identifying the specific cause determines appropriate treatment 1.
Diagnosis and Management
Diagnosis involves measuring prolactin levels, considering age-specific and sex-specific reference ranges, and excluding confounding conditions such as hypothyroidism, renal and/or hepatic impairment, and use of medications that cause hyperprolactinemia 1.
Treatment
Treatment often involves dopamine agonists, with cabergoline being the preferred choice due to its superior effectiveness and lower adverse effect profile 1.
From the FDA Drug Label
As with other drugs that antagonize dopamine D2 receptors, RISPERIDONE elevates prolactin levels and the elevation persists during chronic administration. RISPERIDONE is associated with higher levels of prolactin elevation than other antipsychotic agents. RISPERIDONE has been shown to elevate prolactin levels in children and adolescents as well as in adults.
Risperidone increases prolactin levels, and this elevation persists during chronic administration. This effect is associated with hyperprolactinemia, which may lead to various symptoms such as galactorrhea, amenorrhea, gynecomastia, and impotence. The increase in prolactin levels is dose-dependent and generally greater in females than in males across indications 2 2.
From the Research
Factors that Increase Prolactin Levels
- Certain antipsychotic medications, such as risperidone and haloperidol, can increase prolactin levels 3, 4, 5
- Dopamine antagonists, which block the action of dopamine, a neurotransmitter that inhibits prolactin release, can also increase prolactin levels 6
- Pituitary tumors, such as prolactinomas, can produce excess prolactin 7, 6
- Hypothyroidism, renal failure, cirrhosis, and chest wall lesions can also increase prolactin levels 6
- Certain medications, such as phenothiazines and butyrophenones, can increase prolactin levels by blocking dopamine receptors 5
Effects of Antipsychotics on Prolactin Levels
- Risperidone has been found to persistently elevate prolactin levels 3, 4, 5
- Clozapine, olanzapine, quetiapine, and ziprasidone have been found to have little effect or produce decreases in prolactin levels 5
- Aripiprazole has been found to produce significant reductions in prolactin levels while maintaining therapeutic efficacy for psychosis 3, 5
Management of Hyperprolactinemia
- Dopamine agonists, such as bromocriptine and cabergoline, can be used to treat hyperprolactinemia 7, 3, 6, 4
- Reducing the dose of the offending antipsychotic or switching to a different antipsychotic with a lower risk of hyperprolactinemia can also be effective 3
- In some cases, surgery or radiotherapy may be necessary to treat pituitary tumors or other underlying causes of hyperprolactinemia 7, 6