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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by JohnL on November 12, 2000, at 16:14:29
Andrew,
You mentioned Mirapex as a possibility for controlling prolactin while taking Amisulpride. Is that right? And it didn't counteract the good effects of Amisulpride, is that right?I can't recall because it was a while back, but I think I remember there was something about Mirapex that you didn't like? What was it?
This is probably related to my previous question, but why do you not take Mirapex now?
I'm just curious. Mirapex is one of several options on my radar screen and I would like to learn more about it. If you could, please tell me about your experiences with it and anything else you think might be helpful for me to know.
Thanks Andrew!
John
Posted by SLS on November 12, 2000, at 17:27:42
In reply to Andrew, Mirapex?, posted by JohnL on November 12, 2000, at 16:14:29
Dear John,
When I suggested to you that you look into trying Mirapex or Requip to treat your impotence, it wasn't because of the potential for these drugs to lower prolactin levels. Specifically, it was because they are potent D3 agonists. D3 reception stimulation in the paraventricular nucleus of hypothalamus is involved in the production of an erection. As a D3 agonist, Mirapex would help combat the potent D3 antagonist properties of amisulpride. I am sorry that you didn't understand me.
Hyperprolactinemia does not seem to produce impotence at a rate of any statistical significance.
If you still have a sex drive, I doubt your prolactin levels are elevated enough to cause impotence.
If for some reason you want to lower your prolactin levels, go for the D2 receptor agonist, bromocryptine.
My other suggestion of trying sulpiride might be a worthwhile alternative should Mirapex not help.
- Scott
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1: Prog Urol 1999 Dec;9(6):1097-101
[Should plasma prolactin assay be routinely performed in the
assessment of erectile dysfunction? Report of a series of 445
patients. Review of the literature].[Article in French]
Delavierre D, Girard P, Peneau M, Ibrahim H
Service d'Urologie-Andrologie, CHR La Source, Orleans, France.
OBJECTIVE: To define the value of plasma prolactin assay in the
assessment of erectile insufficiency. MATERIAL AND METHODS: Plasma
prolactin assay (radioimmunoassay) was performed in 445 patients
presenting with erectile insufficiency (mean age 52.5 years).
RESULTS: 9 patients (2%) presented plasma prolactin levels greater
than 25 ng/ml and 4 (0.9%) of them had levels higher than 35
ng/ml. Eight of these 9 patients were taking hyperprolactinaemic
drugs. The aetiology remained unclear in 1 patient, but the
pituitary gland was normal on CT scan. REVIEW OF THE LITERATURE:
In the population of men with erectile insufficiency, 2.7% of
subjects have plasma prolactin levels greater than 20 or 25 ng/ml.
1.3% have levels greater than 35 or 40 ng/ml and 0.6% present
pituitary tumours. In the case of pituitary tumours responsible
hyperprolactinaemia and erectile insufficiency: 1) plasma
prolactin is greater than 30 ng/ml in 90% of cases and greater
than 50 ng/ml in 83% of cases; 2) total plasma testosterone is
less than 3 ng/ml in 88% of cases and less than 4 ng/ml in 96% of
cases; 3) libido is decreased in 90% of cases. CONCLUSION: The
prevalence of hyperprolactinemia and pituitary tumours in the
population of men with erectile insufficiency is low. Moreover,
certain criteria are suggestive of hyperprolactinemia, especially
when it is secondary to a pituitary tumour. Consequently, routine
plasma prolactin assay is not justified. This assay should only be
performed when libido is impaired, total plasma testosterone is
decreased or when the patient presents certain signs such as
headache, gynaecomastia or visual disturbances.Publication Types: Review Review, multicase
PMID: 10658257, UI: 20122718
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10: Prog Urol 1998 Sep;8(4):537-41[Erectile dysfunction secondary to hyperprolactinemia. Apropos of
13 cases].[Article in French]
Abram F, Linke F, Kalfon A, Tchovelidze C, Chelbi N, Arvis G
Service d'Uro-Andrologie, Hopital Tenon, Paris, France.
Hyperprolactinemia is the cause of erectile dysfunction in less
than 1% of cases. From 1989 to 1996, 13 patients consulted for
erectile disorders associated with hyperprolactinemia. The mean
age was 47.5 years. 10 patients complained of decreased libido. 3
patients had gynecomastia. Plasma prolactin levels ranged from
31.3 ng/ml to 1,300 ng/ml. 7 patients had a plasma testosterone
less than 4 ml/ng. 7 patients had a micro- or macroadenoma of the
sella turcica visualized by MRI. After drug treatment, plasma
prolactin levels returned to normal in all patients in whom assays
were performed. 6 patients considered that their erectile function
was restored. 5 of the 6 patients with no improvement of their
sexual function had a concomitant disease able to explain the
impotence. Hyperprolactinemia is a rare cause of erectile
dysfunction, but it must be considered in any patient presenting
with idiopathic erectile dysfunction associated with decreased
libido, gynecomastia, and decreased plasma testosterone. Drug
treatment is effective and MRI of the sella turcica should be
performed looking for a pituitary adenoma.PMID: 9834517, UI: 99051582
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