Medicines for the Treatment of Hyperprolactinemia

Definition

As the word itself suggests, hyperprolactinemia is a clinical condition in which the levels of prolactin in the blood are higher than the normal range. breast, is involved in lactation. The excessive production of prolactin leads to the plasma accumulation of the hormone (hyperprolactinemia, in fact), accompanied by galactorrhea and interruption of the menstrual cycle (amenorrhea).

Causes

Hyperprolactinemia can reflect a serious pathological condition; the exaggerated increase in the levels of prolactin in the blood can be favored by: taking drugs (antidepressants, dopamine receptor antagonists, opiates, drugs for the treatment of angina, antihypertensive central - e.g. alpha-methyldopa etc.), chronic renal failure, hypothyroidism, severe liver injury, microadenoma, radiotherapy, sarcoidosis, overtraining, pituitary tumor.

Symptoms

Among the most recurrent symptoms, growth retardation (delayed puberty) is an omnipresent element in childhood hyperprolactinemia. In the female (adult) variant, however, it is observed that 90% of affected women complain of galactorrhea, oligomenorrhea, amenorrhea or other irregularities menstrual, to these symptoms, are added decreased libido, infertility and hirsutism. In men, hypeprolactinemia often causes erectile dysfunction.

The information on Hyperprolactinemia - Drugs for the Treatment of Hyperprolactinemia is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Hyperprolactinemia - Drugs for the Treatment of Hyperprolactinemia.

Medicines

The reestablishment of serum prolactin levels is the first goal to be achieved, easily obtainable in the milder forms: just think, for example, of the forms of hyperprolactinemia dependent on the administration of certain drugs (it is sufficient to interrupt the therapy and the simultaneous intake of active alternative) or related to hypothyroidism (the intake of thyroid hormones is normally able to bring the prolactin values back into the physiological range).
Different speech for the hyperprolactinemia derived from adenomas and microadenomas: the therapeutic treatment is evidently more delicate. However, it is necessary to underline the discrepancy between the therapeutic hypotheses of some authors - convinced that the accumulation of prolactin in the blood can be resolved with a pharmacological treatment specifically aimed at the destruction of microadenomas - and of others, who believe, instead, that the most suitable therapy is waiting, driven by the conviction that the microadenoma can stabilize (never grow) over time. The two different theories of therapeutic approach seem, however, if hyperprolactinemia is associated with serious secondary disorders, such as serious menstrual disorders and osteoporosis: in such circumstances, pharmacological intervention is essential.

We speak of hyperprolactinemia due to pituitary adenoma when the prolactin values in the blood exceed 200 nanograms per milliliter

Among the most used drugs for the treatment of severe hyperprolactinemia dependent on adenomas, dopamine agonists are the therapy of choice: the intake of these drugs seems in fact to rapidly reduce the levels of prolactin in the blood, as well as favoring the remission of prodrome in a very short time.
In patients suffering from adenoma and hyperprolactinemia, who do not respond positively to drug therapy, radiotherapy (aimed at decreasing the size of the tumor), or surgery is recommended: radiation therapy is normally the first choice, since recent scientific statistics show that the risk of recurrence following a surgery to eliminate cancer cells is much higher than that derived from radiotherapy.
For the treatment of hyperprolactinemia independent of adenomas, in women who do not wish to become pregnant, it is recommended to take the combined contraceptive pill (with estrogen and progestin hormones), aimed at regulating the menstrual cycle altered by the variation in the concentration of prolactin.

We speak of hyperprolactinemia due to amenorrhea when the prolactin values in the blood exceed 25 nanograms per milliliter

The following are the classes of drugs most used in the therapy against hyperprolactinemia, and some examples of pharmacological specialties; it is up to the doctor to choose the active ingredient and the dosage most suitable for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Dopamine agonists: these drugs excellently exert their therapeutic action as hypoprolatinmics for the treatment of adenomas with lack of control of prolactin synthesis. The drugs act at the pituitary and hypothalamic level, as well as clearly reducing the size of the pituitary adenomas (which produce prolactin). In most cases, therapy with these drugs (for the treatment of adenomas) must be continued for life , given that a suspension of the use of the drug often causes the tumor to re-form.
Some of the medications listed below are also indicated to reduce breast pain (or breast tenderness) that characterizes PMS.

Bromocriptine (Bromocriptine DRM, Parlodel): For adults with hyperprolactinamia, it is recommended to take a drug dose ranging from 1.25 to 2.5 mg once daily. It is possible to increase the dose by 2.5 mg every 2-7 days. The maintenance dose suggests administering 2.5-15 mg of the drug per day. For hyperprolactinemic children between 11 and 15 years of age, take 1.25-2.5 mg of the drug per day. Do not exceed 10 mg per day. Consult your doctor.
Cabergoliana (Dostinex): for the treatment of hyperprolactinamia, it is recommended to take 0.5 mg of the drug orally twice a week. The dosage may increase by 0.25 mg at intervals of at least 14 days. Do not exceed one milligram , twice a week. It should be emphasized that the dosage must always be perfected by the treating physician, on the basis of the levels of prolactin in the blood. The drug has a long duration of action, therefore it can be administered once every 2-3 days, according to as indicated by the doctor; in some patients, even a single weekly administration is sufficient. Long-term therapy with this drug may favor a decrease in blood pressure, associated with hallucinations, nausea, vomiting.
Pergolide (eg. Pergolide EG): powerful drug to be used only in case of no response following treatment with Cebergoline or Bromocriptine. Start therapy with a drug dose of 0.05 mg, to be taken once a day. If necessary, increase the dose by 0.025-0.05 mg, after checking the prolactin values in the blood. Typically, patients benefit from taking 0.1 mg of the drug orally once a day.
Zinc sulfate (eg. Zincometil): for acute hyperprolactinaemia, it is recommended to administer 37.5 mg of zinc sulphate (diluted in 20 ml of deionized water) every 30 minutes, for 4 hours, so that the levels of prolactin in the blood restore.

Drugs for the treatment of hyperprolactinemia dependent on hypothyroidism: some forms of hyperprolactinemia are triggered by an inability, on the part of the thyroid gland, to ensure the right amount of hormones required by the body to meet its needs. In this case, the Prolactin levels in the blood can return to normal following a therapy to treat the underlying problem. Below are the main drugs and pharmacological specialties most used in therapy for this purpose:

Levothyroxine sodium (eg. Eutirox, Syntroxine, Tiracrin, Tirosint)
Liothyronine sodium (eg. Liotir, Titre)

For the posology: read the article on drugs for the treatment of hypothyroidism

Symptomatic therapy for the treatment of adenoma-independent hyperprolactinemia: we have seen that hyperprolactinemia can cause serious alterations on female fertility, causing amenorrhea (lack of menstruation) or oligomenorrhea (delay in menstruation of more than 4 days). In this case, to control the symptoms, it is recommended to take the estrogen-progestogen birth control pill (when the woman does not want to have a child). Here are some examples of birth control pills used in therapy for the treatment of symptoms of hyperprolactinemia:

Ethinylestradiol / Levonorgestrel (eg Loette, Microgynon, Miranova, Egogyn): these are contraceptive pills, indicated primarily to block ovulation (contraceptive effect) and secondly to regulate the frequency of menstruation in the context of hyperprolactinemia. These drugs are available in packs of 21-28 tablets: each tablet consists of 0.02 mg of ethinylestradiol and 0.1 mg of levonorgestrel.Pharmacological treatment involves taking one tablet a day, for 21 days, possibly at about the same time each day, followed by a free interval of one week.
Desogestrel / Ethinylestradiol (eg Gracial, Novynette, Lucille, Dueva, Securgin): these are coated tablets of 20 mcg of ethnylestradiol and 150 mcg of desogestrel. The dosage of these drugs reflects the one described above: the correct way of taking these active ingredients guarantees a regularity of the cycle in the context of hyperprolactinemia.