Prolactinomas - Common questions
- Can I drink alcohol when taking bromocriptine, cabergoline or quinagolide?
- Can my tablets be stored at room temperature?
- What happens if I miss a tablet or cannot remember whether I have taken
one?
- Is medical therapy safe?
- Are these drugs safe if I become pregnant?
- I’ve heard that women with prolactinomas can sometimes develop
complications during pregnancy – is this true?
- Can I nurse after delivery?
- Do all patients with prolactinomas need treatment?
- How long will I have to be on medical therapy?
- What are my fertility prospects as a man with prolactinoma?
- Is medical treatment better than surgery for prolactinomas?
- Does prolactinoma run in families?
- Is it safe to take an oral contraceptive pill if I have a prolactinoma?
1.Can I drink alcohol when taking bromocriptine, cabergoline or quinagolide?
Yes,
in moderation, but check with your doctor for advice on your specific drinking
habits.
2.Can my tablets be stored at room temperature?
Yes, bromocriptine,
cabergoline and quinagolide can all be stored at room temperature. However,
please note that the cabergoline bottle has a moisture-absorbing gel in its
cap and this should not be removed.
3. What happens if I miss a tablet or cannot remember whether I have taken
one?
There should be no problem. If you are taking bromocriptine or quinagolide,
just start again with the next tablet. For cabergoline, a delay of one or
two days will not make much difference because the drug is very long-acting.
However, in general terms, regular tablet taking is important for the success
of your treatment.
4. Is medical therapy safe?
Yes, bromocriptine has been in clinical
use for more than 20 years, while cabergoline and quinagolide have been used
for more than 10 years. All have an excellent safety record. Their side effects
have already been described.
5. Are these drugs safe if I become pregnant?
Yes, This is an important
point because many women with a prolactinoma are given one of these drugs with
the specific aim of becoming pregnant. Your doctor will usually recommend that
you stop taking the drug as soon as pregnancy is confirmed. Over 6000 babies
have been born to women who took bromocriptine during pregnancy. There has
been no increased risk of fetal malformation and the children have developed
normally. No problems have been seen with women who took cabergoline or quinagolide,
though the number of such babies is much smaller. Therefore, bromocriptine
is the preferred drug for women with prolactinomas who desire to become pregnant.
6. I’ve heard that women with prolactinomas can sometimes develop complications
during pregnancy – is this true?
The main worry is that prolactinomas
can enlarge during pregnancy. The risk, however, is very small for microprolactinomas
and, even for macroprolactinomas, it is much lower than previously thought.
Nevertheless, thought and clinical consideration must be given to the potential
for tumor growth during pregnancy in each patient with a prolactinoma. If
there is evidence of tumor expansion during pregnancy (eg headaches or visual
problems), then your doctor will probably tell you to start taking bromocriptine
again. Occasionally, pituitary surgery may be required during pregnancy.
7. Can I nurse after delivery?
Yes, you can nurse after delivery. Your
endocrinologist will suggest exactly how to do this, but in general you will
not re-start bromocriptine, cabergoline, or quinagolide. These medications
would inhibit your ability to nurse. After nursing is completed, you would
resume these medications.
8. Do all patients with prolactinomas need treatment?
Most do. If you
have infertility problems, excessive milk production or a large tumor causing
pressure symptoms, then there is a clear case for treatment. If not, then the
need may not seem so clear. However, prolonged sex-hormone deficiency (estrogen
in women and testosterone in men) causes thinning of the bones, or osteoporosis,
or in some cases, other problems. Therefore, most doctors believe that women
without regular periods should receive treatment. The same applies to men with
low testosterone levels.
9. How long will I have to be on medical therapy?
You will probably need to take the medication for a relatively long time, with interruption during pregnancy as described earlier. If you have a microprolactinoma, many doctors withdraw treatment for a trial period of a few weeks every two years or so; in some patients the problem seems to disappear during prolonged treatment. If you have a large tumor (macroprolactinoma), your treatment may last many years; tumor control is maintained and side effects during long-term treatment are not usually a problem. In some patients who have both a marked decrease in prolactin levels and tumor size, it may be possible to stop treatment
10. What are my fertility prospects as a man with prolactinoma?
Many
men with prolactinomas are not infertile. If you are, medical treatment alone
may improve your sperm count and lead to the return of normal fertility, although
this could take several months. Additional treatment with hormone injections
(FSH and LH) may also be necessary.
11. Is medical treatment better than surgery for prolactinomas?
Medical
treatment is more effective than is surgical treatment for prolactinomas. The
main problem with medical treatment is that the medication has to be taken
long-term; otherwise the prolactin level usually rises and symptoms return
soon after stopping treatment. On the other hand, surgery involves a general
anaesthetic, is often ineffective in curing large tumors, and there may be
complications, such as loss of normal pituitary function. In addition, tumors
may recur after surgery. However, if the surgeon is able to remove the prolactinoma
completely and leave the normal pituitary tissue intact, then patients may
be cured of their prolactinoma. The chances of this happening depend on the
size of the prolactinoma and the skill and experience of the surgeon.
12. Does prolactinoma run in families?
No, nearly all cases are isolated.
Very rarely, more than one member of a family may have a prolactinoma, but
this is sufficiently uncommon for you not to have to worry about it.
13. Is it safe to take an oral contraceptive pill if I have a prolactinoma?
Yes.
You should discuss this with your physician.
