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Hyperprolactinemia

Menopause

Prescribing Information and information on adverse event reporting can be found at the bottom of the page.

Selecting Treatment Based on Guidelines

Therapeutic Goals and Options

Adapted from Peña KS, et al, 2001. and Halperin, et al, 2013.

Adapted from Melmed, et al, 2011.

Treatment Algorithm

According to guidelines from the Endocrine Society, patients with hyperprolactinaemia only require treatment when symptomatic (hypogonadism, infertility, galactorrhoea, decreased BMD).1  The type of hyperprolactinaemia dictates the appropriate type of treatment.

Dopamine Agonists

Dopamine agonists are strongly recommended as first-line treatment for many patients with symptomatic hyperprolactinaemia given their consistent benefits with regard to patient outcomes.3

Dopamine Agonist Options

Several dopamine agonists are available for the treatment of hyperprolactinemia.3
Click each tab to explore more about each Dopamine Agonist used to treat hyperprolactinaemia:

Cabergoline4

    Dose (Per Approved Labeling)
• Start: 0.5 mg/week
• Increase by 0.5 mg per week until prolactin levels are normal
• Maximum dose: 3 mg on any 1 day (no more than 4.5 mg/week)

    Dosing Frequency
• 1 or 2 times per week

 Notes
• Long-half-life allows for once- or twice-weekly administration
•  It is recommended that cabergoline be taken with meals
• Very common side effects (may affect more than 1 in 10 people): Valvulopathy (including regurgitation) and related disorders (pericarditis and pericardial effusion), headache, dizziness/vertigo, nausea, dyspepsia, gastritis, abdominal pain, asthenia and fatigue.
• Common side effects (may affect up to 1 in 10 people): Somnolence, depression, postural hypotension, hot flushes, constipation, vomiting, breast pain, asymptomatic decreases in blood pressure (≥20 mmHg systolic and ≥10 mmHg diastolic).

Cabergoline is licensed for the treatment of dysfunctions associated with hyperprolactinaemia, including amenorrhoea, oligomenorrhoea, anovulation and galactorrhoea. Cabergoline is indicated in patients with prolactin-secreting pituitary adenomas (micro- and macroprolactinomas), idiopathic hyperprolactinaemia, or empty sella syndrome with associated hyperprolactinaemia, which represent the basic underlying pathologies contributing to the above clinical manifestations.
Please see product SmPC for full details

Bromocriptine5

      Dose (Per Approved Labeling)
• Irrespective of the final dose, the optimum response with the minimum side effects is best achieved by gradual introduction for the treatment of hyperprolactinaemia
•For Adults:
   ⇒ Initially: 1-1.25 mg/day at bedtime, increasing after 2-3 days to 2-2.5mg
at bed time
    ⇒ Then increase by 1mg at 2-3 day intervals, until a dose of 2.5mg twice daily is achieved
   ⇒ Dose may then be increased by 2.5mg daily at 2-3 day intervals until prolactin levels are normal
   ⇒ Maximum dose: 30 mg/day
Most patients with hyperprolactinaemia have responded to 7.5mg daily, in divided doses, but doses of up to 30mg daily have been used

​​​​​​
​  Notes
• First drug used to treat hyperprolactinemia; introduced >30 years ago
• Short half-life requires frequent dosing​​​​​
• Should always be taken with food
• Prescribing in children and adolescents (aged 7-17) should be limited to Paediatric Endocrinologists.
• Common side effects (affect less than 1 in 10 people): Headache, Drowsiness, Feeling and being sick, Constipation, Blocked nose.

Bromocriptine is licensed for the treatment of hyperprolactinaemia in men and women with hypogonadism and/or galactorrhoea. 
Please see product SmPC for full details

Quinagolide6

   ​ Dose (Per Approved Labeling)
• Start: 25 µg/day for 3 days
• Increase to 50 µg/day for 3 days
• Maintain a dose of 75 µg/day from day 7 onwards
• Dose may be increased by stepwise 75-150 µg/day, as necessary
• Maximum dose: Doses of ≥300 μ/day are required in less than 1/3 of patients


​ Dosing Frequency
• 1 time per day


Notes
• Since dopaminergic stimulation may lead to symptoms of orthostatic hypotension, the dose should be initiated gradually, and given only at bedtime.
• Very common side effects (affect more than 1 in 10 patients treated): Nausea, Vomiting, Headache, Dizziness, Tiredness
• Common side effects (affect between 1 in 10 and 1 in 100 patients treated): Anorexia, Abdominal pain, Constipation or diarrhoea, Insomnia, Oedema, Flushing, Nasal congestion and a drop in blood pressure which may result in fainting.
​​​​
Quinagolide is licensed for the treatment of hyperprolactinaemia (idiopathic or originating from a prolactin-secreting pituitary microadenoma or macroadenoma).
Please see product SmPC for full details

   
Dostinex (cabergoline) prescribing information can be found here


References
1. Peña KS, Rosenfeld JA. Evaluation and treatment of galactorrhea. Am Fam Physician. 2001;63(9):1763- 1670.
2. Halperin Rabinovich I, Cámara Gómez R, García Mouriz M, Ollero García-Agulló D; Grupo de Trabajo de Neuroendocrinología de la SEEN. Clinical guidelines for diagnosis and treatment of prolactinoma and hyperprolactinemia. Endocrinol Nutr. 2013;60(6):308-319.
3. Melmed S, Casanueva FF, Hoffman AR, et al; Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.2011;96(2):273-288.
4. Cabergoline Summary of Product Characteristics; May 2017.
5. Bromocriptine Summary of Product Characteristics; June 2018. Available at:https://www.medicines.org.uk/emc/product/1202 (Accessed June 2022)
6. Quinagolide Summary of Product Characteristics; October 2016. Available at:https://www.medicines.org.uk/emc/product/7367/smpc (Accessed June 2022)


PP-UNP-GBR-0580. June 2022

Monitoring and Management

Learn how to tailor therapy based on follow-up testing 
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Learn more

What is Hyperprolactinaemia?

See general information including pathophysiology and etiology​​​​​​​
​​​​​​​​​​​​​​

Learn more

Identifying Common Symptoms

Understand what signs to look for and explore two patinet case studies
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Learn more

Interpreting Test Results

Recognise which tests to order and what the results indicate
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Learn more

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PP-PFE-GBR-3863. November 2021

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