Hyperprolactinemia evaluation

Brunelleschi S, Zeppegno P, Risso F, Cattaneo Cl, Torre E. Risperidone-associated hyperprolactinemia evaluation in twenty psychiatric outpatients. Pharmacol Res 2003 48 405-9. 

Five patients (four women and one man, aged 30-45 years), who were evaluated for risperidone-induced hyperprolactinemia, had significant hyperprolactinemia, with prolactin concentrations of 66-209 pig/1 (1017). All but one had manifestations of hypogonadism, and in these four patients, risperidone was continued and a dopamine receptor agonist (bromocriptine or cabergoline) was added in three patients this reduced the prolactin concentration and alleviated the hypogonadism. 

Sexual Side Effects and Hyperprolactinemia. Clinical evaluation of the sexual function effects of antipsychotic agents are fraught with methodological difficulties including reduced sexual performance in unmedicated schizophrenics. The few well-con-trolled studies that have appeared have involved male subjects (74,75). 

Cabergoline is commercially available as 0.5-mg oral tablets. The initial dose of cabergoline for the treatment of hyperprolactinemia is 0.5 mg once weekly or in divided doses twice weekly. This dose may be increased by increments of 0.5 mg at 4-week intervals based on serum prolactin concentrations. The usual dose is 1 to 2 mg weekly however, doses as high as 4.5 mg weekly have been used. Recent studies have also evaluated the efficacy of a vaginal dosage form of cabergoline to reduce the adverse effects associated with oral therapy. ... 

Figure 26.2 Effects of castration and hormone replacement or hyperprolactinemia on prostate D1 activity. For sex hormone replacement, rats were bilaterally castrated via the scrotal route and treated with supraphysiological doses of testosterone (1.0 mg) and/or estrogen (20 rg). Hormones were administered by slow delivery in oil via s.c. Hyperprolactinemia was induced by implanting one pituitary under the kidney capsule of animals whose pituitary remained intact. D1 activity was measured by the radiolabeled iodide release method (n = 5 rats/group). Data were analyzed with one-way ANOVA, and differences between means were evaluated by the Tuckey test. Different letters indicate significant differences between groups, p < 0.05. D1, type 1 deiodinase T, testosterone E2, 17p-estradiol. Data adapted from Anguiano et al., (2006).

Systematic reviews The efficacy of domperidone in diabetic gastroparesis has been evaluated in a systematic review of 28 clinical trials in a total of 1016 patients [7 ]. Domperidone improved symptoms, enhanced gastric emptying, and reduced hospital admissions in 60-70% of trials. None of the studies assessed the risk of adverse reactions to domperidone versus comparators. The most common adverse reaction was hyperprolactinemia, but in no case was it serious. 

Another study evaluated whether the long-term use of ergot-derived dopamine agonists for hyperprolactinemia may be associated with increased risk of significant valvular heart disease. A total of 74 patients (mean age 48 1.4 years, 23% male) with prolactinoma treated with the drugs for at least lyear were evaluated with... 

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