Citation: Saran M Nair et al (2021). Drug Induced Expressible Galactorrhea in Patient with Fibromyalgia and Vascular Headache. Saudi J Med, 6(8): 275-278. 275 Saudi Journal of Medicine Abbreviated Key Title: Saudi J Med ISSN 2518-3389 (Print) |ISSN 2518-3397 (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: https://saudijournals.com Case Report Drug Induced Expressible Galactorrhea in Patient with Fibromyalgia and Vascular Headache Saran M Nair 1* , Dr. Renoy A Henry 2 , Roshni PR 3 1 PharmD Intern, Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India – 682041 2 Associate Professor, Department of General Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India -682041 3 Assistant Professor, Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India -682041 DOI: 10.36348/sjm.2021.v06i08.007 | Received: 28.06.2021 | Accepted: 15.08.2021 | Published: 29.08.2021 *Corresponding Author: Saran M Nair Abstract Drug-induced Galactorrhea associated with Hyperprolactinemia has been rarely reported with agents such as antidopaminergic, antiemetics, antidepressants etc. Galactorrhea related with Hyperprolactinemia is an unwanted consequence of the treatment in which there is an increased serum prolactin levels usually associated with an abnormal whitish fluid like secretion from the breast. We report a case of expressible Galactorrhea at multiple occasions in a 44- year-old female patient with Fibromyalgia and Vascular headache related to Fluoxetine, Amitriptyline, Flunarizine, Domperidone used at different intervals of treatment. This report highlights the mechanism of these drugs which induces galactorrhea and subsequent reduction in the side effect when the active drugs are withdrawn. Keywords: Hyperprolactinemia, Galactorrhea, Prolactin, Fluoxetine, Amitriptyline, Flunarizine, Domperidone. Copyright © 2021 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited. INTRODUCTION Drug-Induced Hyperprolactinemia associated with Galactorrhea is an undesirable effect that has been rarely reported with agents such as antidopaminergic, antiemetics, antipsychotics, anti-depressants, etc [1]. Selective serotonin reuptake inhibitors (SSRI) and Tricyclic antidepressants are less considered to cause galactorrhea [2, 3]. Fluoxetine and Amitriptyline is a class of selective serotonin reuptake inhibitors and tricyclic antidepressants respectively. Serotonin stimulates prolactin release directly through postsynaptic 5- Hydroxytryptamine receptors in the hypothalamus [4], or indirectly by inhibition of 5-HT mediated tuberoinfundibular dopaminergic neurons [5]. Fluoxetine and Amitriptyline induced Galactorrhea is not often reported among anti-depressant related side effects. Domperidone is a peripherally acting Dopamine receptor antagonist, which has a dominant role in gastric and intestinal smooth muscle motility and is commonly used to relieve the symptoms such as nausea, vomiting and hiccoughs. The drug as an anti- emetic blocks the dopamine receptors in the chemoreceptor trigger zone present in the anterior pituitary which results in the elevation of serum prolactin usually <100ng/ml. Neurological adverse effects and hyperprolactinemia are reported rarely. Abdominal cramps, diarrhoea, constipation, mastalgia are the least observed side effects of the drug treatment. Flunarizine, a calcium antagonist which is widely used for the treatment of migraine and vertigo, hinder central dopaminergic systems which may increase basal and stimulated prolactin levels with a consequent resetting of a hypo-modulated central opioid tonus toward normal values. We are reporting a case of a 44-year-old lady who developed an expressible Galactorrhea associated with Hyperprolactinemia while on treatment with these Drugs on different occasions. Fluoxetine, Amitriptyline, Domperidone, Flunarizine. CASE HISTORY 44-year-old female patient with a known case of Fibroid Uterus and had s/p TLH+B/L salpingectomy. Clinical diagnosis of the patient was made and presented to the OP with complaints of Fatigue, Generalised aches and pains, Fibromyalgia and Vascular headache. She was then started on Tab Fluoxetine 10mg 0-0-1 which showed a progressive improvement in the patient’s complaints. However, the