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Moussaoui J, Barrimi M. Sertraline-Induced Galactorrhoea: A Case Report. Cureus 2024; 16:e62357. [PMID: 39006722 PMCID: PMC11246568 DOI: 10.7759/cureus.62357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Patients taking various treatments frequently report galactorrhoea as a side effect. Psychotropic drugs, especially neuroleptics, are among the treatments most likely to cause this effect. Conventional tricyclic antidepressants rarely cause galactorrhea. The advent of new selective serotonin reuptake inhibitor (SSRI) antidepressants purported to reduce such side effects. We report the clinical case of a patient with galactorrhoea on Sertraline as well as our therapeutic approach in light of data from recent scientific literature.
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Affiliation(s)
- Jihane Moussaoui
- Psychiatry, Faculty of Medicine and Pharmacy Oujda, Mohammed First University, Oujda, MAR
| | - Mohammed Barrimi
- Immunohematology and Cellular Therapy Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
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Maeshima T, Iijima R, Watanabe M, Yui S, Itagaki F. Effect of antipsychotics on breast tumors by analysis of the Japanese Adverse Drug Event Report database and cell-based experiments. J Pharm Health Care Sci 2021; 7:13. [PMID: 33789764 PMCID: PMC8015017 DOI: 10.1186/s40780-021-00199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/25/2021] [Indexed: 08/14/2024] Open
Abstract
Background Since antipsychotics induce hyperprolactinemia via the dopamine D2 receptor, long-term administration may be a risk factor for developing breast tumors, including breast cancer. On the other hand, some antipsychotic drugs have been reported to suppress the growth of breast cancer cells in vitro. Thus, it is not clear whether the use of antipsychotics actually increases the risk of developing or exacerbating breast tumors. The purpose of this study was to clarify the effects of antipsychotic drugs on the onset and progression of breast tumors by analyzing an adverse event spontaneous reporting database and evaluating the proliferation ability of breast cancer cells. Methods Japanese Adverse Drug Event Report database (JADER) reports from April 2004 to April 2019 were obtained from the Pharmaceuticals and Medical Devices Agency (PMDA) website. Reports of females only were analyzed. Adverse events included in the analysis were hyperprolactinemia and 60 breast tumor-related preferred terms. The reporting odds ratio (ROR), proportional reporting ratio (PRR), and information component (IC) were used to detect signals. Furthermore, MCF-7 cells were treated with haloperidol, risperidone, paliperidone, sulpiride, olanzapine and blonanserin, and cell proliferation was evaluated by WST-8 assay. Results In the JADER analysis, the IC signals of hyperprolactinemia were detected with sulpiride (IC, 3.73; 95% CI: 1.81–5.65), risperidone (IC, 3.69; 95% CI: 1.71–5.61), and paliperidone (IC, 4.54; 95% CI: 2.96–6.12). However, the IC signal of breast tumors was not observed with any antipsychotics. In cell-based experiments, MCF-7 cells were treated with six antipsychotics at concentrations of 2 and 32 μM, and none of the drugs showed any growth-promoting effects on MCF-7 cells. On the other hand, blonanserin markedly suppressed the growth of MCF-7 cells at a concentration of 32 μM, and the effect was concentration dependent. Conclusions Analysis of the JADER using the IC did not show breast tumor signals due to antipsychotic drugs. In in vitro experiments, antipsychotics did not promote MCF-7 cell proliferation whereas blonanserin suppressed MCF-7 cell growth. Further research on the effects of blonanserin on the onset and progression of breast tumor is expected.
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Affiliation(s)
- Tae Maeshima
- Department of Clinical & Pharmaceutical Sciences, Faculty of Pharma Science, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Ryosuke Iijima
- Department of Medical & Pharmaceutical Sciences, Faculty of Pharma Science, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Machiko Watanabe
- Department of Clinical & Pharmaceutical Sciences, Faculty of Pharma Science, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Satoru Yui
- Department of Medical & Pharmaceutical Sciences, Faculty of Pharma Science, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Fumio Itagaki
- Department of Clinical & Pharmaceutical Sciences, Faculty of Pharma Science, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
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Vilar L, Vilar CF, Lyra R, Freitas MDC. Pitfalls in the Diagnostic Evaluation of Hyperprolactinemia. Neuroendocrinology 2019; 109:7-19. [PMID: 30889571 DOI: 10.1159/000499694] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/17/2019] [Indexed: 11/19/2022]
Abstract
An appropriate diagnostic evaluation is essential for the most appropriate treatment to be performed. Currently, macroprolactinemia is the third most frequent cause of nonphysiological hyperprolactinemia after drugs and prolactinomas. Up to 40% of macroprolactinemic patients may present with hypogonadism symptoms, infertility, and/or galactorrhea. Thus, the screening for macroprolactin is indicated not only for asymptomatic subjects but also for those without an obvious cause for their prolactin (PRL) elevation. Before submitting patients to macroprolactin screening and pituitary magnetic resonance imaging, one should rule out pregnancy, drug-induced hyperprolactinemia, primary hypothyroidism, and renal failure. The magnitude of PRL elevation can be useful in determining the etiology of hyperprolactinemia. PRL values >250 ng/mL are highly suggestive of prolactinomas and virtually exclude nonfunctioning pituitary adenomas (NFPAs) and other sellar masses as the etiology of hyperprolactinemia. However, they can also be found in subjects with macroprolactinemia, drug-induced hyper-prolactinemia or chronic renal failure. By contrast, most patients with NFPAs, drug-induced hyperprolactinemia, macroprolactinemia, or systemic diseases present with PRL levels <100 ng/mL. However, exceptions to these rules are not rare. Indeed, up to 25% of patients harboring a microprolactinoma or a cystic macroprolactinoma may also have PRL <100 ng/mL. Falsely low PRL levels may result from the so-called "hook effect," which should be considered in all cases of large (≥3 cm) pituitary adenomas associated with normal or mildly elevated PRL levels (≤250 ng/mL). The hook effect may be unmasked by repeating PRL measurement after a 1:100 serum sample dilution.
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Affiliation(s)
- Lucio Vilar
- Division of Endocrinology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil,
- Pernambuco Endocrine Research Center, Recife, Brazil,
| | | | - Ruy Lyra
- Division of Endocrinology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil
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Carvalho AF, Sharma MS, Brunoni AR, Vieta E, Fava GA. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:270-88. [PMID: 27508501 DOI: 10.1159/000447034] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
Abstract
Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.
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Affiliation(s)
- André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Özten E, Hizli Sayar G, Göğçegöz Gül I, Ceylan ME. Sertraline Induced Galactorrhea. Noro Psikiyatr Ars 2015; 52:202-203. [PMID: 28360706 DOI: 10.5152/npa.2015.7314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022] Open
Abstract
There is limited literature reporting galactorrhea with antidepressants, including selective serotonin reuptake inhibitors. In this case report, a patient with adjustment disorder who developed galactorrhea with sertraline was presented.
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Affiliation(s)
- Eylem Özten
- Department of Psychology, Üsküdar University, Humanities and Social Sciences Faculty, İstanbul, Turkey
| | - Gökben Hizli Sayar
- Department of Psychology, Üsküdar University, Humanities and Social Sciences Faculty, İstanbul, Turkey
| | - Işıl Göğçegöz Gül
- Department of Psychology, Üsküdar University, Humanities and Social Sciences Faculty, İstanbul, Turkey
| | - Mehmet Emin Ceylan
- Department of Psychology, Üsküdar University, Humanities and Social Sciences Faculty, İstanbul, Turkey
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Abstract
Drug-induced galactorrhea has been reported with agents such as antidopaminergic antiemetics, antipsychotics, etc., with few case reports of galactorrhea with selective serotonin reuptake inhibitors, including paroxetine, being reported in last few decades. Prolactin levels have been found to be either raised or normal in these cases. We here report a case of paroxetine induced galactorrhea in a 48-year-old female patient of obsessive compulsive disorder, having hyperprolactinemic and euprolactinemic galactorrhea at different time with a pituitary incidentaloma.
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Affiliation(s)
- Prannay Gulati
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - B S Chavan
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
| | - Subhash Das
- Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India
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Nebhinani N. Sertraline-induced galactorrhea: case report and review of cases reported with other SSRIs. Gen Hosp Psychiatry 2013; 35:576.e3-5. [PMID: 23260337 DOI: 10.1016/j.genhosppsych.2012.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/21/2012] [Accepted: 10/23/2012] [Indexed: 11/29/2022]
Abstract
There is limited literature reporting galactorrhea with antidepressants including selective serotonin reuptake inhibitors (SSRIs). In this case report, I present a case of a young female who developed galactorrhea with sertraline, which improved on discontinuation of sertraline. Computer-assisted searches on galactorrhea with SSRIs yielded 23 cases, mostly with escitalopram and paroxetine and rarely with fluoxetine, fluvoxamine and sertraline, and it may be much more frequent than recognized.
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Affiliation(s)
- Naresh Nebhinani
- Department of Psychiatry, Postgraduate Institute Medical Science, Rohtak, Haryana, 124001, India.
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Trenque T, Herlem E, Auriche P, Dramé M. Serotonin Reuptake Inhibitors and Hyperprolactinaemia. Drug Saf 2011; 34:1161-6. [DOI: 10.2165/11595660-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Marked mydriasis and neuritis nervi optici associated with galactorrhea following citalopram treatment: a case report and discussion. Case Rep Med 2011; 2011:191735. [PMID: 21869891 PMCID: PMC3160104 DOI: 10.1155/2011/191735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/27/2011] [Indexed: 11/18/2022] Open
Abstract
We report the case of a 25-year-old women suffering from major depression who was treated with citalopram for several weeks with doses between 20 mg and 60 mg. She gradually developed marked mydriasis within 2 months after treatment and subsequently neuritis nervi optici. Moreover, abrupt galactorrhea occurred after 2 months of treatment. All neuro-ophthalmological, neurophysiological, clinical laboratory, and neuroradiological diagnostic efforts did not reveal an underlying organic pathophysiology. The ocular symptoms disappeared rapidly after the discontinuation of citalopram and pulse therapy with methyl-prednisolone. However, galactorrhea persisted for a few weeks necessitating treatment with bromocriptine.
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