This protocol addresses the symptomatic patient with suspected medication-induced hyperprolactinemia — currently taking a drug known to elevate prolactin — in whom the initial step of discontinuing the causative agent was attempted but serum prolactin failed to return to normal.
The patient is symptomatic and prolactin elevation is attributed to a currently prescribed medication. The central management question is whether the offending drug can be stopped or replaced, with remeasurement of serum prolactin confirming whether the intervention was sufficient.
The prior approach — discontinuing the causative drug for approximately 3 days and then remeasuring serum prolactin — was attempted. The goal of that step was normalization of serum prolactin. Because prolactin did not return to normal after discontinuation, the next management step is now indicated.
When complete discontinuation of the offending drug is not clinically feasible, the next consideration involves substituting an alternative agent — one with a comparable therapeutic action but without the prolactin-elevating effect. The full protocol specifies which options apply and what follows if substitution is also not possible.
DOI: 10.1210/jc.2010-1692
In a symptomatic patient with suspected drug-induced hyperprolactinemia, we suggest discontinuation of the medication for 3 d or substitution of an alternative drug, followed by remeasurement of serum prolactin.
If this is not possible, a drug with a similar action that does not cause hyperprolactinemia should be substituted, and if this is not feasible we suggest considering the cautious administration of a dopamine agonist in consultation with the patient's physician.
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