Lactation following psychotropic agents

Lactation Following Psychotropic

The first case of lactation due to chlordiazepoxide is presented. This report does not prove beyond a doubt, but certninly does incriminate chlordiazepoxide as an iatrogenic factor as a cause of lactation in this case. The probable mechanism is hypothalamic stimulation

or suppresion

Agents

permitting

anterior

pitui-

tary release of lactogenic hormone. Similar effects can be expected with other ataractic and psychotropic drugs. (Metabolism 16: No. 3, Larch, X7-2% 1967)

Dieth~lstill,estrol was atlministertd for a p~riotl of 1 week in ;I tlosagt- c,t 1.5 mg. tlnil\ without nplxeciable etfect tpn thrx pin or secretion. The patient was then gi\,cn placebc~ tlllc. ttr Gtlr c,lfrrts. chlordiazepoxide c2lx~1les l)llt 11x1 to tliscolltinue these after 2 wrrlis One month later. the breasts hut1 rt$llrnecl to normal :%ntl the srrretion colrlpletc~ly tlisal~pear’d. Studies were Imcl~rtakell which ir;tlicatrtl that th\ roitl flmvtiotl \v,lr; 11ornIal (PHI 4.S mcg. per cent. RAILI 26.:3 per cent at 24 11011rs) whjle slid x-ri\\h I’?\ tdrtl 110 pine:il 01 cella abnormality. Chlordiazeposidr 10 mg. c1.i.d. was again qivcn starting on hlarcl~ :30. 1966, and after 2 months tht> pntic~nt again hat1 gy nc-conrastia ant1 col~im~~ milk! secretioll. It is of particular interest to note that this patient rrceivul cl~lortli~~zel~o~i~l~~ for 2 lxrid of 3 months dnring hrr h! pc.rth! roitl period ( lH6:3 ) witliollt tlr\-~~lol)in~ tlrcksc, trl;lrrifchtations. 111scuss105-

Reports have appeared ixq>licating the following drugs in thus protluetioii 01 lactation: trifluoroperazine dihydrochloride, l~rochlorprr~~zi~le.’ mel~rol)amatt~,’ h\-dro~liloridc.” ehlorthioridazine hydrochloride,1 fluphenazine.’ imipraminc This is the first rcprt of promazine.:’ alpha-methyl-dolled,’ aud rrserpine.’ lactation following chlordiazepoxide. IIypotlialamic coiitrol of tli(h pituitar\ gonadotrophic hormones has been postulated but uot definitelv proved. This focuses attention ou the hypothalamus as thca eontrollin g center for tlit. pitutary release of lactogenic hormone. Logically such effects c’aii I)e c~xpeetr~tl from other psychotropic drugs. It has tentativelv l)cleu suggested that the trancluilizing drugs rna!~ rcmovct some hypothalamic rrstrainiug mechanism over the release of auterior pituitarv hormones.” L’k i raise, hyl~otlialamic stimulation mav cause thrs release of ;I factor which then stimulates the anterior pituitarv to ~rcllrase laetogeuic hormone. Estrogen deficicncv in l~ost~~ieiiol~;~~is”1 nwmen #\-es risr, to ail increasc~tl excretion of lactogenic hormone.’ It is notable that the vaginal smear in this patient indicated a moderate estrogen eflcct. Also there 11~1s uo resl~ouse to the aclrninistration of large doses of svuthetic estrogen given for a period of 1 \\icek. Careful neurologie examinatic~u am1 sliull x-ravs c~cludcd ;I@itar\. tumor as the cause’. ACKNOWLEDGMENTS ‘l‘hallh~ ar? c~\tcntl~d to 101111 1. l’rpper. \I.D.. Holhl~ann-I ,;I Roclrc~ 111~. t11r I”‘,)\ Itlill< tilt, c~l~lortli~~z~l~o~i~l~placrhc~ c:lp;!lt~ ;liid rca\iew of tlx> Iiiarrllvcript.

REFERENCES I. Hooper, 1. H., Shackclforcl.

\r.. Welch. H.’ T.: .~bnord

V.

C.. and lactation

associated with trnnqnilizing clrllg therspy. j.L~.-\I.A. 178:506, 1961. 2. Klein. J. J., Srxgal, R. I,., and Warner. R. R.: Calactorrhra cllle to imilxxnine. Report of a cast. .\rw En<. 1, \ied. 271:510. 1064. 13. hlo! er. 1. II.. Kinross-\Vright, \... and Finney, 1~. \I.: Chlorpromazine as ;I therapeutic agent ill clinical medicine. Arch. Int. Sltd. %5:202. 1933. 4. l’ettinger. \V. .\., Horwitz. D., and

Sjoerdsma. \ltlopa.

I.nct;ltion

.J.:

Brit. \I.

t111r to rll($lb-

1. 1:1460.

1963.

.i. Kohinaon. H.: Rrcast clran,q:rh ill tha 111;ih ;md

femnlr

I-c~serpine 239.

\vith

chlorprrm~uin~

therap.

\I.

I..,

.\ll,crt.

0,

1. :\1Istralia

2:

1937.

(i. Brxcker.

I;.

ta\;crction tenizillg 23:062,

alltl

\.:

of folliclt~-\titlrrll~~tin(ir hornmnc+.

1, Clin.

I’vin;ln antI 111.

Entlclcrinc,l.

1965.

7. Heichlin, S.: Nr~~roc~~~tl~~~ri~~olo~~. Eng. J. Sled. 269: 1189. 1963.

‘\(3\