Antipsychotics and hyperprolactinaemia: mechanisms, consequences and management

Abstract

Hyperprolactinaemia is a common side effect in people receiving antipsychotics. The propensity to cause hyperprolactinaemia differs markedly between antipsychotics as a result of differential dopamine D(2) receptor-binding affinity and ability to cross the blood-brain barrier. Sexual dysfunction is common and under-recognized in people with severe mental illness and is in part caused by hyperprolactinaemia. There are a number of long-term consequences of hyperprolactinaemia, including osteoporosis. Regular monitoring before and during treatment will help identify those developing antipsychotic-induced hyperprolactinaemia. The treatment includes dose reduction and change in antipsychotic. Where this is not possible because of the risk of relapse of the mental illness, sex steroid replacement may be helpful in improving symptoms secondary to hypogonadism and reducing the risk of osteoporosis. Tertiary prevention of complications should also be considered.

Paliperidone-Related Gynecomastia and Treatment: a Case Report

“…Some authors recommend routine screening, whereas others do not recommend or recommend screening for just high-risk drugs and patients (11,13,14). There is no consensus on whether the patient's prolactin levels should be monitored at follow up visits, either.…”

“…There is no consensus on whether the patient's prolactin levels should be monitored at follow up visits, either. While some authors recommend quarterly or annual prolactin levels evaluations, treatment guidelines generally recommend analyzing prolactin levels when the patient develops symptoms (11,13,14). According to the Schizophrenia Treatment Guideline of the Psychiatric Association of Turkey it is recommended: a) to check the baseline prolactin level of all patients, b) to repeat prolactin analysis after 3 months in patients who have no signs of hyperprolactinemia in the follow-ups, but use risperidone, paliperidone, amisulpride or typical antipsychotic drugs, c) in case of moderate elevation in prolactin level, to question symptom progression and effects and to repeat prolactin test every 6 months; and d) in case of a significant elevation in prolactin level, either to change medications or to treat hypogonadism.…”

Decrease In Serum Prolactin Levels After Long-acting Injectable Aripiprazole Treatment: A case report

“…In the literature, some reports stated that oral aripiprazole addition lowers prolactin levels in hyperprolactinemia cases with the use of both oral and injectable paliperidone (9). If the patient provides benefit from the antipsychotic treatment, it is suggested that adding oral aripiprazole to the treatment may be better option (10). In our case, we added oral aripiprazole according to the literature but weak oral treatment adherence caused sustained hyperprolactinemia, despite we had lowered the paliperidone palmitate dosage from 100 mg to 75 mg/mont.…”

Guidelines for Antipsychotic-Induced Hyperprolactinemia

“…Women of reproductive age, particularly parous women, appear to be at higher risk of hyperprolactinemia than postmenopausal women. 1 Nonetheless, pretreatment prolactin screening in a patient started on an antipsychotic regimen allows for less diagnostic confusion in the event of potential hyperprolactinemia, permitting greater confidence in a diagnosis of medication-induced hyperprolactinemia. 1 For example, if it is clear that an increase in prolactin level follows the initiation of antipsychotic therapy, and no features of pituitary disease (such as headache and visual disturbances) are present, then further investigation is unnecessary.…”

“…1 The strongest predictors of hyperprolactinemia are the type and dose of the antipsychotic prescribed, with increased levels observed at higher doses. 2 In the case of typical antipsychotics, antipsychotic efficacy correlates with elevation in prolactin level.…”