Medication class | Frequency of prolactin elevation* | Mechanism |
Antipsychotics, first generation | ||
Chlorpromazine | Moderate | Dopamine D2 receptor blockade within hypothalamic tuberoinfundibular system. |
Fluphenazine | High | |
Haloperidol | High | |
Loxapine | Moderate | |
Perphenazine | Moderate | |
Pimozide | Moderate | |
Thiothixene | Moderate | |
Trifluoperazine | Moderate | |
Antipsychotics, second generation | ||
Aripiprazole | None or low | Dopamine D2 receptor blockade. |
Asenapine | Moderate | |
Clozapine | None or low | |
Iloperidone | None or low | |
Lurasidone | None or low | |
Olanzapine | Low | |
Paliperidone | High | |
Quetiapine | None or low | |
Risperidone | High | |
Ziprasidone | Low | |
Antidepressants, cyclic | ||
Amitriptyline | Low | Not well understood. Possibly by GABA stimulation and indirect modulation of prolactin release by serotonin. |
Desipramine | Low | |
Clomipramine | High | |
Nortriptyline | None | |
Antidepressants, SSRI | ||
Citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline | None or low (rare reports) | Same as for cyclic antidepressants. |
Antidepressants, other | ||
Bupropion, venlafaxine, mirtazapine, nefazodone, trazodone | None | Not applicable. |
Antiemetic and gastrointestinal | ||
Metoclopramide | High | Dopamine D2 receptor blockade. |
Domperidone (not available in United States) | High | |
Prochlorperazine | Low | |
Antihypertensives | ||
Verapamil | Low | Not well understood. Specific to verapamil. May involve calcium influx inhibition within tuberoinfundibular dopaminergic neurons. |
Methyldopa | Moderate | Decreased conversion of L-dopa to dopamine; suppression of dopamine synthesis. |
Most other antihypertensives (including other calcium channel blockers) | None | Not applicable. |
Opioid analgesics | ||
Methadone, morphine, others | Transient increase for several hours following dose | Potentially an indirect effect of mu opiate receptor activation. |
GABA: gamma-aminobutyric acid; SSRI: selective serotonin reuptake inhibitor.
* Frequency of increase to abnormal prolactin levels with chronic use: high: >50%; moderate: 25 to 50%; low: <25%; none or low: case reports. Effect may be dose dependent.Do you want to add Medilib to your home screen?