Alright gents,
Wouldn’t mind some input regarding this issue,
My prolactin levels are high due to an an anti-emetic medication (Domperidone) I have to use to manage my severe (non-diabetic) gastroparesis which was likely triggered by an infection I picked up while I was out in Cambodia 2.5 years ago.
Domperidone raises prolcation due to it’s anti-dopaminergic properties with strong antagonism at the D2 and D3 receptors, much in the same way the anti-psychotics drugs do. Fortunately, Domperidone does not cross the blood-brain-barrier so it tends not to induce extrapyramidal symptoms.
I try to use it as a little as possible, normally 3 times a week, when my nausea becomes the most unbearable and my other methods for nausea control aren’t working, regrettably severe nausea is still very frequent.
I use other anti-emetics on a PRN basis too such as Prochlorperazine and Odansetron; these are reasonable to an extent, but the first is annoyingly sedating and has similar anti-dopaminerigc properties, and the latter is expensive; also, both don’t have the pro-kinetic effect on the stomach and small bowel which is what I’m after to reduce my symptoms.
Prolactin after last draw is 346 mu/L (0-330).
Total test levels are currently reasonable at 24.0 nmol/L.
(Note: these are are UK units, I believe the value units are different in the US.)
Haven’t been able to get any E2, FT or LH readings recently so can’t get quite a full picture of my total hormonal profile, regrettably. My GP is normally quite helpful, but like most is about out of her depth here.
I am currently asymptomatic with regards to acute hyperprolactinemia apart from an increase in water retention and generally feeling like sh1t (though being nauseated all the time will do that). However, I want to ensure any further damage isn’t done, or things worsen.
With regards to options, here’s what I’ve researched tentatively,
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Vitamin p-5-p. The biologically active form vitamin b-6. Seems to have a reasonable anecdotal reports for directly lowering prolactin at 50-200mg. Major drawback is that P5P seems to have some rather active effects on serotonergic transmission and thus CV affects. I’m also on both low-dose SSRI Citalopram and low-dose Nortryptyline. p5p could theoretically raise blood levels of both meds and have some cardiac effects, so some caution is warranted.
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A medium strength aromatase inhibitor such as 6-bromo. My endocrinology knowledge is limited, but wouldn’t blocking estrogen and ergo boositng test, also lower prolactin signalling?. If so, this might well be a better first line option.
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Pramipexole. I considered using this some years ago as a primary anti-depressant, but with my nausea so prevalent, I decided against it due to it’s propensity for causing nausea as a side-effect. So that would be potentially pouring petrol onto the fire for me. A low dose might be worth considering though…
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Levo-dopa through mucuna pruriens extract. Similar pathway as Prami, though using the dopamine precursor as oppose to agonsing the recpetors directly. I suppose the effects might be variable so is worth considering if one doesn’t work out.
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Cabergoline. The heavy artillery. I know this works very well for guys in PCT, but might be overkill in my own context plus has the same risk of further nausea as a side-effect much like the Prami. Would probably be my last-chance saloon option.
My instinct is to go conservatively with the p5p and if I have no problems with that work up to 200mg. If I start getting serotonin syndrome effects, the 6 bromo seems likes the next best option. If that isn’t effective, then the mucuna pruriens or the Pramipexole. Then the Cabergoline.
Any other suggestions for anti-prolatcin meds or other methods for reducing prolactin. In an ideal world I wouldn’t have to use the fucking Domperidone at all, but this is a tricky condition to manage and the med is the best of a bad bunch with regards to pro-kineticism of the stomach.
Thanks for your time.
