Prolactin Drugs


DRUGS CAUSING HYPERPROLACTINAEMIA Drug-induced increases in prolactin do not usually lead to levels above 2,500 mU/L Occasionally drug-induced prolactin levels up to 6,000 mU/L may be observed Where levels are above 2,500 mU/L, further investigations are indicated Drugs are a common cause of hyperprolactinaemia
Drug group	Specific Examples	Comments
Classic neuroleptics (antipsychotic drugs)	Perphenazine, fluphenazine, flupenthixol, thioridazine, promazine, halperidol, loxapine, chlorpromazine, sulpiride	Increase serum prolactin levels profoundly. Prevalence of galactorrhoea has been shown to be 19%.
Atypical neuroleptics	Amisulpride, sertindole, risperidone	May cause hyperprolactinaemia although prevalence is unclear. Clozapine induces lesser increases in prolactin and may be used as an alternative in patients who have developed hyperprolactinaemia on other drugs.
Anti-emetics	Metoclopramide, domperidone	Common. Metoclopramide causes a five-fold increase in prolactin levels in healthy volunteers.
Selective serotonin reuptake inhibitors	Citalopram, fluoxetine, fluvoxamine, paraoxetine, sertraline.	Currently most frequent cause of hyperprolactinaemia. Approximately eight-fold increased risk of galactorrhoea compared with other antidepressants.
Tricyclic antidepressants	Amitriptyline, doxepin, clomipramine,	Rarely cause hyperprolactinaemia
Cardiovascular drugs	Verapamil, reserpine, methyldopa	Of the calcium channel blockers only verapamil has a significant prolactin releasing effect.
Oestrogens	High dose oral contraceptives	Current use of contraceptive pills with low doses of oestrogens means that less than 1% of women show hyperprolactinaemia.
Opiates		Opiates have acute prolactin-releasing effects, which may be maintained with chronic therapeutic use or abuse.
Miscellaneous	Bezafibrate Omeprazole Trimethoprim Histamine H₂ antagonists	Occasionally.

Reference: Korbonits M, Grossman AB. Drug-induced hyperprolactinaemia. Prescribers J 2000; 40(2): 157