From the Guidelines
Mild elevation in prolactin can be caused by various factors, including medications, physiological conditions, and medical conditions, with medications being one of the most common causes in adults, as reported in a 2024 study published in Nature Reviews Endocrinology 1.
Causes of Mild Elevation in Prolactin
Mild elevation in prolactin (hyperprolactinemia) can be caused by several factors, including:
- Medications, such as antipsychotics, certain antidepressants, metoclopramide, and some antihypertensives, which can stimulate prolactin secretion or antagonize inhibitory dopaminergic tone 1
- Physiological conditions, such as pregnancy, breastfeeding, and stress, which can naturally increase prolactin levels
- Medical conditions, including hypothyroidism, chronic kidney disease, liver cirrhosis, and polycystic ovary syndrome, which can cause mild elevations in prolactin levels 1
- Other factors, such as sleep disruption, intense exercise, and nipple stimulation, which may also temporarily elevate prolactin levels
Importance of Baseline Macroprolactin Levels
According to a 2024 consensus guideline published in Nature Reviews Endocrinology, baseline macroprolactin levels should be assessed where serum prolactin is found to be mildly or incidentally elevated 1. This is because macroprolactin, a form of prolactin with low biological activity, can circulate in the blood and may be present in individuals with hyperprolactinemia.
Clinical Implications
If you have unexplained elevated prolactin, it's essential to review your medication list with your healthcare provider and consider underlying medical conditions that might require treatment. Additionally, prompt and appropriate secondary analysis should be undertaken to detect the possible presence of macroprolactin in the initial investigation of asymptomatic individuals with hyperprolactinemia 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 can cause a mild elevation in prolactin levels due to its dopamine D2 receptor antagonism properties 2.
From the Research
Causes of Mild Elevation in Prolactin
- Antipsychotic medications, particularly first-generation antipsychotics, can cause hyperprolactinemia due to their ability to block dopamine activity at the level of the dopamine type 2 receptor (D2R) 3, 4, 5, 6
- The risk of hyperprolactinemia is higher with certain antipsychotics, such as risperidone, sulpiride, and amisulpride 5, 6
- Metformin can cause a mild reduction in prolactin levels, but may also contribute to a mild elevation in some cases 4
- Other factors, such as stress, renal failure, or hypothyroidism, can also contribute to hyperprolactinemia 7
- Herbal supplements, such as chamomile, Peony-Glycyrrhiza decoction, and shakuyaku-kanzo-to, may have some effect on prolactin levels, but the evidence is limited 4
Factors Influencing Prolactin Levels
- Dose and duration of antipsychotic treatment can impact prolactin levels, with higher doses and longer treatment durations associated with greater increases in prolactin 5, 6
- Individual variability in response to antipsychotics and other medications can also influence prolactin levels 4, 6
- Presence of other medical conditions, such as pituitary adenomas or hypothyroidism, can affect prolactin levels and should be considered in the diagnosis and treatment of hyperprolactinemia 3, 7