Which medications raise prolactin?

Bottom lineThe medications that most often raise prolactin are antipsychotics (risperidone most of all, sometimes past 100 to 200 ng/mL), metoclopramide and domperidone, some SSRIs and tricyclic antidepressants, verapamil, cimetidine, opioids, and estrogen. They work by blocking the dopamine brake that normally holds prolactin down. Never stop a psychiatric medication yourself to lower a prolactin level - take it to the prescriber, who can switch drugs, adjust the dose, or treat the consequences instead.

Antipsychotics are the biggest cause, followed by the anti-nausea drugs metoclopramide and domperidone, some antidepressants, verapamil, cimetidine, and opioids. Medication is one of the most common reasons for a high prolactin, and one of the most frequently overlooked.

Why it happens

Prolactin is held down by a dopamine brake. Any drug that blocks dopamine releases that brake and lets prolactin rise. That is exactly how antipsychotics and metoclopramide work on other symptoms - the prolactin rise is a side effect of the intended mechanism.

The main culprits

• Antipsychotics - risperidone causes the largest rises, sometimes past 100 to 200 ng/mL; haloperidol and others also raise it
• Metoclopramide and domperidone - anti-nausea and gut-motility drugs
• Antidepressants - some SSRIs and tricyclics, usually milder rises
• Verapamil - a blood pressure medication
• Cimetidine - an acid reducer
• Opioids
• Estrogen, including in some hormonal contraceptives

What to do about it

Do not stop or change a medication on your own, especially a psychiatric one. Stopping an antipsychotic to lower a lab value can be far more dangerous than the raised prolactin itself.

Instead, bring it to the prescriber. Depending on the drug and your symptoms, the options usually include leaving it alone (if you have no symptoms), switching to an agent less likely to raise prolactin, adjusting the dose, or treating the consequences - such as low estrogen - directly.

A drug cause is also worth suspecting when the level is moderately rather than dramatically high. Levels over about 200 ng/mL point more towards a prolactinoma than a medication.

More in prolactin in women and how high prolactin is treated.

Femora's cycle log helps you show a prescriber exactly when your periods changed relative to starting a medication.