Drug induced hyper prolactinemia: interesting observations.

Introduction: Drugs are a common cause of hyperprolactinemia. It is essential to differentiate this cause from other pathological causes which avoids unnecessary investigations.Thorough history will help us in finding the responsible drug and holding the same will be rewarding. Here we are reporting such cases of drug induced hyperprolactinemia. Methods: It was a cross-sectional observational study. Subjects were recruited from our outpatient department. Hyperprolactinemia was defined as blood prolactin levels >30 ng/mL in females and >24 ng/mL in males, regardless of the presence of symptoms.Serum prolactin was repeated one week after holding the suspected drug(s).Drug induced hyperprolactinemia defined,if holding of responsible drug made normalization of prolactin levels.Results: Total of 32 subjects were studied in this study with age of 35.5±10.8years.Predominantly female subjects were present with female to male ratio 5.4. Basal prolactin was 132±68.7ng/mL and after holding the drug prolactin value was 16.9±8.2. Proton pump inhibitors in combination with prokinetics were the leading cause (71.8%) and followed by multiple drug combinations (15.6%), anti-psychiatric drugs (9.3%) and oral contraceptives (3.1%). The mean prolactin in the combination of levosulpride was 176 ng/dl, whereas with domperidone it was 126 ng/dl & with oral contraceptives, respiridone it was 134,151ng/dl respectively.Conclusion: Majority cases were clinically symptomatic. Among female subjects commonest presentation was galactorrhea followed by irregular menses and breast heaviness and men presented with erectile dysfunction.Contrary to common belief in our study PPI with prokinetic combination is the most common offending agent than anti-psychotic agents. Levosulpride being the most potent drug in inducing hyper prolactinemia than other agents, though the popular belief was with the Risperidone. As the utility of PPI prokinetic combination is increasing, this might replace anti-psychotic agents as most potent & most common etiology for drug induced hyper prolactinemia.