Das, Bhagwan

Nadeem, Sarah

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eCommons@AKU Section of Diabetes, Endocrinology and Metabolism Department of Medicine 4-2020 Levosulpiride-induced hyperprolactinemia Sarah Nadeem Aga Khan University, sarah.nadeem@aku.edu Bhagwan Das Aga Khan University, bhagwan.kanayo@aku.edu Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_med_diabet_endocrinol_metab  Part of the Endocrine System Diseases Commons, and the Endocrinology, Diabetes, and Metabolism Commons Recommended Citation Nadeem, S., Das, B. (2020). Levosulpiride-induced hyperprolactinemia. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 30(4), 457-457. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_diabet_endocrinol_metab/86 LETTER TO THE EDITORJournal  of  the College of  Physicians and Surgeons Pakistan 2020,  Vol.  30(4):  457 457Levosulpiride-induced Hyper-prolactinemiaSir,Dyspepsia is a common concern of patients in both the hospitaland  outpatient  settings.  For  symptomatic  treatment  of  this,there are many over-the-counter drugs available in our country.Levosulpiride  is  commonly  used  for  dyspepsia,  since  thisbecame available as a new prokinetic agent in Pakistan without aprescription.Previously,  prokinetic  agents  like  domperidone  and  metoclo-pramide have been reported to cause hyperprolactinemia as oneof  their  unavoidable  side  effects  by  blocking  central  D2dopamine receptors at the hypothalamus and anterior pituitarylevel.1 However, this side effect of these old drugs in causinghyperprolactinema was moderate, usually in the range of <100ng/mL.  Recently,  a  few cases  have been reported with  levo-sulpiride, causing increased serum prolactin in the range of >200ng/mL.2Here, we present two patients who were diagnosed with levo-sulpiride-induced hyperprolactinemia with their prolactin levelnormaliSing with discontinuation of this drug. The first patientwas a 40- year woman referred to Endocrinology Unit for the eval-uation of galactorrhoea. Her serum prolactin was reported as49.40 ng/mL (normal range: 4-18.5 ng/mL). The second patientwas a 28-year woman who presented with a history of irregularperiods  for  a  few  months,  serum  prolactin  checked  by  herprimary physician was 109.5 ng/mL, who then referred her toEndocrinology Unit for further workup and management.On detailed history taking, both admitted that they had beenexperiencing  acid  peptic  symptoms  and  were  taking  Levo-sulpiride tablets of 25 mg and 50 mg, two to three times per day,respectively for the last 3-4 months prior to their presentation.They were advised to stop this agent and follow-up in the clinicafter 1 month with repeat serum prolactin level. After one month,both reported improvement in their initial symptoms and repeatprolactin levels were 24 ng/mL and 40.40 ng/mL, respectively.Levosulpiride acts via antagonising central D2 dopamine recep-tors and show its therapeutics as well as adverse effects likehyperprolactinemia by that mechanism.Data  regarding  levosulpiride-induced  hyperprolactinemia  isscarce. Lozano et al. in his prospective  study of 342 participantshas reported galactorrhoea in 26.7% patients on levosulpiride.3Our intent in sending this communication is to help create aware-ness  amongst  health  professionals  regarding  the  associationbetween levosulpiride and raised serum prolactin levels. In themanagement process, the first step should be to discontinue levo-sulpiride, repeat prolactin level in a few weeks; and if prolactinlevels normalise, then avoid unnecessary costly workup.CONFLICT OF INTEREST:Authors declared no conflict of interest. AUTHORS’ CONTRIBUTION:BD: Came up with the idea to write this letter and designed thisletter.SN: Reviewed it  critically and both authors approved the finalversion to be published.REFERENCESMajumdar A, Mangal NS. Hyperprolactinemia. J Hum Reprod1.Sci 2013; 6:168-75.Kuchay  MS,  Mithal  A.  Levosulpiride  and  serum  prolactin2.levels. Indian J Endocrinol Metab 2017; 21:355-8.Lozano R, Concha MP, Montealegre A, de Leon L, Villalba JO,3.Esteban HL, et al. Effectiveness and safety of levosulpiride inthe treatment of dysmotility-like functional dyspepsia. TherClin Risk Manag 2007; 3:149-55.Bhagwan  Das  and  Sarah  Nadeem..................................................................................Department  of  Endocrine,  The  Aga  Khan  University  Hospital,Karachi,  Pakistan..................................................................................Correspondence  to:  Dr.  Bhagwan  Das,  Department  ofEndocrine,  The  Aga  Khan  University  Hospital,  Stadium  Road,Karachi,  PakistanE-mail:  dr_bhagwandas@yahoo.com...................................................................Received: September 04, 2019;   Revised: November 07, 2019;Accepted:  November  07,  2019DOI:  https://doi.org/10.29271/jcpsp.2020.4.457

Levosulpiride-induced hyperprolactinemia

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1085&amp;context=pakistan_fhs_mc_med_diabet_endocrinol_metab

Levosulpiride-induced hyperprolactinemia

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