Precautions for medications for hyperprolactinemia

For every patient, how to treat the disease is a top priority. For hyperprolactinemia, drug treatment is the first choice, and the commonly used drug is bromocriptine mesylate. This drug has a satisfactory effect in reducing prolactin, can shrink pituitary tumors, and restore pituitary and ovarian functions. Regarding the many issues of how patients with hyperprolactinemia can take bromocriptine correctly, the following is a detailed introduction to the precautions for hyperprolactinemia patients.

Start taking bromocriptine at a low dose

The common dose of bromocriptine is 2.5-10 mg per day, taken in 2-3 times. The specific dose depends on the degree of increase in blood PRL levels. Professor Li reminds everyone that in order to reduce the side effects of the drug, it is necessary to start with a small dose and then gradually increase it. The initial dose is 1.25 mg each time, 2-3 times a day; taking it during meals can reduce side effects such as nausea and headache. Increase by 1.25 mg every 3 days, measure the PRL value regularly, and adjust the treatment dose individually. For patients who cannot tolerate severe side effects, bromocriptine can also be inserted into the vagina for treatment. Generally, PRL can be significantly reduced after two weeks of medication, and galactorrhea will stop after 4 weeks of medication. After 3 months of medication, most patients resume menstruation and ovulation may occur

In addition to bromocriptine, quinagolide and vitamin B6 are also used to treat hyperprolactinemia.

During the medication period, you should pay attention to the following checkups: ① Check the PRL level once a month, and the doctor will adjust the drug dosage according to the situation. If the PRL level is well controlled after three consecutive checkups, it can be changed to a checkup every six months; ② If there is a pituitary macroadenoma, regular pituitary MRI and visual field examination should be performed.

Do not stop taking the drug immediately after prolactin is controlled normally

For patients taking bromocriptine, relapse after stopping the medication is a common problem. So how to stop the medication correctly to reduce relapse? Professor Li said that the previous view was that lifelong medication was necessary, but after years of follow-up investigation, it is now more advocated to continue to maintain a stable medication for 5 years after blood prolactin returns to normal, and then gradually stop taking bromocriptine to effectively reduce the relapse rate.

The recurrence rate is highest in the first year after stopping the medication, so regular check-ups are required. In the first year after stopping the medication, PRL should be checked every 3 months, and then every 6 months to 1 year. Once prolactin is found to be elevated again, treatment should be started again, and a pituitary MRI should be performed if necessary. When re-treatment after stopping the medication, it should still be started at a low dose and the dose should be adjusted continuously.

Patients with hyperprolactinemia should not stop taking medication immediately after pregnancy

Finally, Professor Li reminded all expectant mothers that bromocriptine has no obvious toxic side effects on the fetus, nor will it cause fetal malformations. Since high levels of prolactin in early pregnancy can cause luteal insufficiency and lead to miscarriage, it is recommended that expectant mothers consider stopping the medication after more than 2 months of pregnancy, when the fetal heart rate can be heard on ultrasound (the fetal survival is basically stable). If there is a PRL macroadenoma, as long as there are no compression symptoms and neurological symptoms, the medication can be continued during pregnancy.

The chance of PRL adenoma enlarging during pregnancy is very small. Of course, patients with PRL macroadenomas should control PRL levels and pituitary tumor size before pregnancy. After pregnancy, the status of the pituitary tumor should still be closely monitored, and the visual field should be reviewed every 2 months. MRI examinations should be performed when necessary. MRI examinations do not require contrast agents and are not exposed to radiation, so they can be performed during pregnancy.