Although the literature confirms that domperidone therapy is associated with increases in serum prolactin levels and that symptoms of hyperprolactinemia have been reported as a result of using this drug, there is inconsistency with regard to the relationship between dosage or duration of therapy and prolactin level. Furthermore, there is no apparent relationship between serum prolactin level and the severity of symptoms associated with hyperprolactinemia.
A thorough literature search revealed no guidelines for monitoring prolactin. Furthermore, manufacturers of domperi- done do not suggest, or provide guidance on, routine prolactin monitoring for patients receiving this drug. A literature search for pediatric reference ranges for prolactin revealed great variability, depending on the patient population and the assay used to determine serum prolactin. Reference ranges were further categorized by age, sex, growth percentiles, and Tanner staging, all of which might have influenced the measured prolactin levels in the current study. cialis 10 mg
Case reports of adverse effects associated with domperi- done therapy were also identified in the literature search. Nipple tenderness, gynecomastia, galactorrhea, and erectile dysfunction have been reported in adults receiving domperi- done for the treatment of gastrointestinal symptoms. Among pediatric patients, there have been reports of domperi- done-associated extrapyramidal dysfunction, oculogyric crisis, galactorrhea, and gynecomastia.
This chart review appears to be the first study to report the monitoring of serum prolactin levels in pediatric patients who had cystic fibrosis and were receiving domperidone therapy. This practice does not appear to be employed for pediatric patients being treated with domperidone in the absence of cystic fibrosis, either at the Children’s and Women’s Health Centre of British Columbia or at other Canadian pediatric hospitals.
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This study revealed that physicians considered patient reports of GERD symptoms and the results of gastric reflux scanning and gastric emptying studies in assessing the efficacy of a patient’s GERD regimen and determining whether to alter therapy. Although prolactin levels did not assist physicians in monitoring the efficacy of domperidone therapy, they were nonetheless a factor in guiding dosage, specifically for decreasing domperidone dose in cases of elevated prolactin levels, with a view to preventing symptoms of hyperprolactinemia. However, baseline serum prolactin levels were not checked before the start of domperidone therapy in any of the patients in this study, which might have affected interpretation of the data and subsequent therapy. At times, the prolactin value was also used as an indicator of compliance. Four of the patients in this study were questioned about compliance and underwent prolactin monitoring on admission and before discharge. On the assumption that patients would be compliant with therapy while in hospital, the prolactin level might be expected to increase, and this trend was indeed observed, although values remained within the reference range. This finding supports the hypothesis that low levels may indicate poor compliance. However, prolactin levels may not be elevated above the normal reference range while a patient is receiving domperidone, so a single low prolactin value cannot be taken as proof of noncompliance. Paired measurements, obtained at the start and end of the hospital stay, may constitute a better indicator, but further investigation is warranted, as the prolactin level may unexpectedly be lower at discharge than admission.