Hyperprolactinemia treatment

Select appropriate pharmacologic and nonpharmacologic treatments for patients with hyperprolactinemia based on patient-specific factors. 

Dopamine agonists are the first-line treatment of choice for all patients with hyperprolactinemia transsphenoidal surgery and radiation therapy are reserved for patients who are resistant to or severely intolerant of pharmacologic therapy. 

If the prolactin level remains normal for 2 years, reassess the need to continue treatment. Make sure that the patient is taking the lowest effective dose for management of hyperprolactinemia. 

The answer is b. (Hardman, pp 282—283J Central dopamine receptors are divided into Dt and D2 receptors. Antipsychotic activity is better correlated to blockade of D2 receptors. Haloperidol, a potent antipsychotic, selectively antagonizes at Dz receptors. Phenothiazine derivatives, such as chlorpromazine, fluphenazine, and promethazine, are not selective for D2 receptors. Bromocriptine, a selective D2 agonist, is useful in the treatment of parkinsonism and hyperprolactinemia. It produces fewer adverse reactions than do nonselective dopamine receptor agonists... 

It became known to suppress prolactine secretion, and it is therefore a useful tool in the treatment of prolactine dependent disorders, such as galactorrhea associated with hyperprolactinemia and postpartum, as well as certain kinds of sterility (3 - 9). In more elevated doses, the drug is a potent antiparkinsonicum. In addition, there is recent evidence of bromocriptine playing an important role in the trace heavy metals balance of the brain (10). 

Unlabeled Uses Treatment of cocaine addiction, hyperprolactinemia associated with pituitary adenomas, neuroleptic malignant syndrome... 

Atypical antipsychotics cause fewer EPS than do conventional antipsychotics. Clozapine and quetiapine are the least likely to cause EPS and are therefore recommended for treatment of psychosis in patients with Parkinson s disease. With the notable exception of risperidone, atypical antipsychotics cause substantially less hyperprolactinemia than do conventional antipsychotics. Weight gain is a side effect of all atypical antipsychotics except ziprasidone and aripiprazole. Concerns about cardiac conduction delay with ziprasidone therapy exist and warrant consideration in patients who have... 

Insomnia, hypotension, agitation, headache, and rhinitis are the most common side effects of risperidone. These tend to lessen with time. Overall, the drug tends to be well tolerated. Average weight gain associated with risperidone after 10 weeks of treatment is 2.10 kg (AUison et al. 1999). Risperidone does not have significant anticholinergic side effects. Hyperprolactinemia is common. 

It is used in hyperprolactinemia and for suppression of lactation and breast engorgement. It is also useful in parkinsonism because it has levodopa like actions and in the treatment of acromegaly. Dose PROCTINAL 1.25 mg BD. 

Dopamine Dopamine agonists used for treatment of hyperprolactinemia... 

Bromocriptine Activates dopamine D2 receptors Suppresses pituitary secretion of prolactin dopaminergic effects on CNS motor control and behavior Treatment of hyperprolactinemia and Parkinson s disease (see Chapter 28) Administered orally or vaginally Toxicity Gastrointestinal disturbances, orthostatic hypotension, headache, psychiatric disturbances, vasospasm and pulmonary infiltrates in high doses... 

Serotonin pathways are involved in the regulation of prolactin secretion. Amenorrhea, galactorrhea, and hyperprolactinemia have been reported in a patient who was already taking an antipsychotic drug after starting treatment with fluvoxamine (SEDA-17, 20). 

Two women with neuroleptic-drug induced hyperprolactinemia, menstrual dysfunction, and galactorrhea had improvement in these adverse effects during treatment with olanzapine (855). 

The authors suggested that olanzapine may offer advantages for selected patients in whom hyperprolactinemia occurs during treatment with other antipsychotic drugs. 

Bliesener N, Yokusoglu H, Quednow B, Klingmiiller D, Kuhn K. Usefulness of bromocriptine in the treatment of amisulpride-induced hyperprolactinemia. Pharmacopsychiatry 2004 37 189-91. 

A vaginal suppository based on bromocriptine was employed for the therapy of hyperprolactinemia [32]. The rationale of the local vaginal delivery of bromocriptine lies in the noteworthy side effects consequent to oral therapy gastrointestinal disorders, extensive hepatic degradation, and hypotension. The pessary based on bromocriptine proved to be effective in lowering serum prolactin to normal levels after 20 days of local therapy the treatment was well tolerated by the majority of the patients and a minimal vaginal irritation was observed. 

Bromocriptine is a D2 agonist its structure is shown in Table 16-4. This drug has been widely used to treat Parkinson s disease and has also been used to treat certain endocrinologic disorders, especially hyperprolactinemia (see Chapter 37 Hypothalamic Pituitary Hormones), but in lower doses than for parkinsonism. Bromocriptine is absorbed to a variable extent from the gastrointestinal tract peak plasma levels are reached within 1-2 hours after an oral dose. It is excreted in the bile and feces. The usual daily dose of bromocriptine in the treatment of parkinsonism is between 7.5 and 30 mg, depending on response and tolerance. In order to minimize adverse effects, the dose is built up slowly over 2 or 3 months from a starting level of 1.25 mg twice daily after meals the daily dose is then increased by 2.5 mg every 2 weeks depending on the response or the development of adverse reactions. 

The neurotransmitter dopamine has currently found clinical application in the treatment of cardiovascular collapse and shock. Treatment with dopamine-related drugs has been limited to such brain disorders as Parkinson s disease, schizophrenia, and hyperprolactinemias. Accumulating data from animal experiments, however, indicate the possible involvement of dopamine in other diseases and the potential use of dopamine agonists or antagonists in these disorders. Gastrointestinal disturbances (especially duodenal ulcer disease) seem to represent such a group of dopamine-sensitive alterations. 

Prolactin has been shown to increase LH receptor numbers in dwarf mice, seasonally repressed hamsters and hypophysectomized rats (see Ref. 6 for other references). In the hypophysectomized rats the combined effects of prolactin, growth hormone and LH were necessary to maintain the LH receptors [46]. The induction of hyperprolactinemia leads to increased LH receptors. Decreases in serum prolactin levels caused by treatment with compounds that inhibit the release of prolactin (dopamine analogues) decrease LH receptors (see Ref. 6 for other references). 

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