Today I’m going to discuss a case involving a patient concern with inappropriate production of milk (formally known as galactorrhea).  Keep an eye at the end of this post for some MAJOR announcements about upcoming content releases!  For now, here’s the case.

Inappropriate Production of Milk

A 44 year old female has two children that are ages 13 and 8.  She has a history of off and on nausea.  No diagnosis has ever been identified as the cause of this.  She has had episodes of vomiting, but this seems controlled since her recent addition of metoclopramide. She also takes Compazine about 2-3 times per week.

Her other medications include:

• Hydrochlorothiazide 12.5 mg once daily
• Protonix 40 mg daily
• Ibuprofen 400 mg as needed
• Sertraline 50 mg once daily

While she says that the nausea and vomiting has improved, she does note that she has been experiencing leakage of milk from her breasts.  This is new and very unusual for her.  Her other medications have been stable for quite some time.

If you remember the mechanism of action of metoclopramide, it can block dopamine receptors.  Compazine can also block dopamine receptors.  These drugs (along with antipsychotics) can lead to elevations in prolactin levels.  Prolactin is critical in the body to stimulate the mammary glands to produce milk.  In this situation, we have an inappropriate production of milk likely due to the adverse effects of metoclopramide and/or Compazine.

With this patient’s nausea, I would definitely inquire about the use of ibuprofen.  It can be a little hard on the gut for some patients and could possibly contribute to GI upset.  Sertraline can cause some GI upset, but typically it is more diarrhea.

If you are looking for more clinical pearls, you can check out these recent episodes of the Real Life Pharmacology Podcast.

• Metoclopramide
• SSRI’s
• NSAIDs

MAJOR Announcements – I’ve got lots!

1. The All Access Passes for 2019 Test Prep Material are ready to roll! These were reviewed updated and new content created in September/October.  If you are taking any of these exams in the spring or fall of 2019, you won’t want to miss out on these resources!
   • BCPS 6 MONTH ALL ACCESS PASS or 1 YEAR ALL ACCESS PASS
   • BCACP 6 MONTH ALL ACCESS PASS or 1 YEAR ALL ACCESS PASS
   • BCGP 6 MONTH ALL ACCESS PASS or 1 YEAR ALL ACCESS PASS
2. For those seeking NAPLEX Prep Material, I am working on creating a 1 year all access pass as many of you are ready to get started making a game plan to pass this exam.  This should be out within the next week or two with a nice discount!
3. There is going to be 2 MAJOR releases of new products in the next few weeks.  I’m targeting late November/early December.
   • The first one will be the Audible version of The Thrill of The Case.  This is nearly 8 hours of content.  Remember that if you are not an Audible member, you can get your first book for FREE – here’s the original Pharmacotherapy if you want to get started.  Audible is perfect if you have a commute to work or enjoy listening to something other than music while working out.
   • Looking for NAPLEX Prep Material? The second announcement is: My Biggest Project To Date! I have adapted content from BCPS Bullets and the original NAPLEX Nuggets. I have added in new content specific for those seeking to prepare to pass their NAPLEX exam (Compounding, kinetics, and of course math).  The best way I can sum up this project: It will be as if you got the cliffnotes from your entire pharmacy school education! (This project is over 55,000 words and will be a very valuable resource for sure!) I will be releasing this within the next few weeks.  I will provide a blog post to notify you of this release and there will be a discounted release price.  Stay tuned!
4. I’m in awe of the support this blog has received.  Thank you. I’m also in awe of how much support the podcast (Real Life Pharmacology) has received as well.  The podcast has received over 100,000 downloads in less than 1 year.  This is something I never would have anticipated.  Thank you for sharing the podcast with colleagues, friends and students! Please continue to do so!! The ratings and reviews we have received have been so kind as well. Thank you so much!
5. I’ve been booked with the University of Minnesota to give a presentation on Social Media, Education, Entrepreneurship, and Valuable Digital Tools that have helped me grow this blog and podcast.  If you happen to live in the Twin Cities or Duluth, Minnesota, you can check out the flier.  I will be live in Duluth, Minnesota. We are working on more details, but I am hoping to release the recording on YouTube for those that obviously can’t make it.  You can view that announcement here: 12.05.18 Clinical Affairs Seminar Announcement – Eric Christianson – I’d love to meet and chat with all of you!

Have a great rest of your week, I’m looking forward to Thanksgiving soon!

Eric Christianson, PharmD, BCGP, BCPS