TAD = Prolatinemia?

[jakstat33]

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A bit confused over a Qbank question... the question stem is about a 32 y/o female presenting with classic signs of prolactinemia/prolactinoma (galactorrhea, amenorrhea, elevated serum PRL) and asks which drug caused the side effects, and the answer is a trycyclic, SOOO-

I understand the physiology behind all of this, but don't TAD increase levels of Dopamine, and won't this actually inhibit PRL secretion rather than stimulate?? One possible explanation may be that increased peripheral dopamine feedback inhibits central dopamine release, and therefore would cause PRL levels to go up (inhibit an inhibitor)... HMMM, I may have answered my own question, but would love to hear what ya'll have to say....

Cheers

 

[nuclearrabbit77]

yah, that's weird. i don't see how it would cause that. a dopamine blocking antipsychotic perhaps... but a tricyclic?

 

[daisygirl]

I did a google search on this since I did not remember learning that prolactinemia is a side effect of TCA. The only thing I came across was that clomipramine (sp?) may cause prolactinemia. I have no idea why. The other TCAs don't seem to have this side effect. Maybe it is one of those unexplainable side effects 😕 .

 

[jakstat33]

FYI, QBank's answer was Nortriptyline, and also adds the following to the short list of agents that can cause hyperprolactinemia: tranquilizers, methyldopa, narcotics, and phenothiazines

I did a google search on this since I did not remember learning that prolactinemia is a side effect of TCA. The only thing I came across was that clomipramine (sp?) may cause prolactinemia. I have no idea why. The other TCAs don't seem to have this side effect. Maybe it is one of those unexplainable side effects 😕 .

 

[daisygirl]

Ok, I opened up my baby Katzung. Apparently the tricyclics are structurally related to the phenothiazines (if interested- p 269). So, while baby Katzung does not explicitly state that prolactinemia is a side effect of the TCAs, we should be able to figure that out since TCAs are structurally related to the phenothiazine antipsychotics.

Now, I'm going back to read my beloved copy of mmrs

FYI, QBank's answer was Nortriptyline, and also adds the following to the short list of agents that can cause hyperprolactinemia: tranquilizers, methyldopa, narcotics, and phenothiazines