Hyperprolactinemia Due to the Sulpiride Addition to Venlafaxine Treatment: A Case Report

Abstract

Hyperprolactinemia, is the most common hypothalamo-hypopysial endocrine disorder. The most common etiologies are; hypophysis adenoma, chronic kidney failure and antiphyschotic drug use. Normal range of prolactin blood level is below 20–25 ng/ml. Antipsychotic drugs cause hyperprolactinemia by blocking the D2 dopamine receptors in the frontal lobe of the hypophysis. The most common symptoms of hyperprolactinemia due to antipsychotic drug use are: galactorrhea, menstrual cycle dysregulation, amenorrhea, decrease in libido, breast sensitivity, decrease in the bone mineral density. Therefore, it is important to diagnose galactorrhea as early as possible. As far as we know there is no reported cases of hyperprolactinemia induced galactorrhea due to very low dose (50 mg/day) sulpiride use. In this study, we report a case of galactorrhea due to hyperprolactinemia as a result of sulpiride 50 mg/daily drug addition to the venflaxine 150 mg/daily treatment in a depressive patient.

Keywords

• sulpiride,hyperprolactinemia,antipsychotic drugs; depression

Venlafaksin Tedavisine Sülpirid Eklenmesi Sonrası Görülen Hiperprolaktinemi: Olgu Sunumu

Abstract

Hiperprolaktinemi, hipotalamo-hipofizyal eksenin en çok karşılaşılan endokrin bozukluğudur. En sık nedenleri hipofiz adenomları, kronik böbrek yetersizliği ve antipsikotik ilaç kullanımıdır. Prolaktinin normal düzeyi 20–25 ng/ml altındadır. Antipsikotik ilaçlar hiperprolaktinemiye ön hipofizdeki D2 dopamin reseptörlerini bloke ederek neden olurlar. Antipsikotiklerin neden olduğu hiperprolaktineminin en sık belirtileri; galaktore, menstrüel döngü düzensizlikleri, amenore, libidoda azalma, göğüste duyarlılık, kemik mineral dansitesinde azalmadır. Bu nedenle de galaktoreyi erken fark etmek önemlidir. Bilebildiğimiz kadarı ile literatürde sülpiridin çok düşük dozda (50 mg/gün) kullanımı sonrası görülen hiperprolaktinemiye bağlı galaktore olgusu bulunmamaktadır. Bu yazıda depresyon tanısı ile venlafaksin 150 mg/gün kullanan hastanın tedavisine sülpirid 50 mg/gün eklenilmesi sonucu hiperprolaktinemiye bağlı galaktore görülen bir olgu sunulmuştur.

Keywords

• sülpirid,hiperprolaktinemi,antipsikotik ilaçlar; depresyon

References

1. 1. Kinon BJ, Gilmore JA, Liu H, Halbreich UM. Hyperprolactinemia in response to antipsychotic drugs: characterization across comparative clinical trials. Psychoneuroendocrinol 2003;28(2):69–82
2. 2. Wieck, A, Haddad P. Hyperprolactinaemia caused by antipsychotic drugs. BMJ 2002;324:250–2.
3. 3. Green AI, Brown WA. Prolactin and neuroleptic drugs. Endocrinol Metab Clin North Am 1988;17(1):213–23.
4. 4. Torre D, Falorni A, Pharmacological causes of hyperprolactinemia. Ther Clin Risk Manag 2007;3:929–51.
5. 5. Edge DS, Segatore M. Assessment and management of galactorrhea. Nurse Pract 1993;18(6):35–49.
6. 6. Langer G, Sachar EJ, Halpern FS. The prolactin response to neuroleptic drugs. A test of dopaminergic blockade: neuroendocrine. J Clin Endocrinol Metab 1977;45:996–1002.
7. 7. Spitzer M, Siajjad R, Benjamin F. Pattern of development of hyperprolactinemia after initiation of haloperidol therapy.Obstet Gynecol 1998;91:693–5.
8. 8. Haddad PM, Wieck A. Antipsychotic-induced hyperprolactinemia. Drugs 2004;64:2291–314.

9. 9. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA et al. “A method for estimating the probability of adverse drug reactions” Clin Pharmac Ther 1981;30(2):239–45.
10. 10. Stahl SM(2012)Stahl’ın Temel Psikofarmakolojisi. (Çev. Ed. İT Uzbay). İstanbul Tıp Kitabevi, İstanbul, 2012.
11. 11. Rouillon F, Rahola G, Van Moffaert M. Sulpiride in thetreatment of somatoform disorders: results of a Europeanobservational study to characterize the responder profile. J IntMed Res 2001;29:304–13.