Olanzapine-Induced Hyperprolactinemia: Two Case Reports

Abstract

Background: Hyperprolactinemia is a common consequence of treatment with antipsychotics. It is usually defined by a sustained prolactin level above the laboratory upper level of normal in conditions other than that where physiologic hyperprolactinemia is expected. Normal prolactin levels vary significantly among different laboratories and studies. Several studies indicate that olanzapine does not significantly affect serum prolactin levels in the long term, although this statement has been challenged. Aims: Our aim is to report two olanzapine-induced hyperprolactinemia cases observed in psychiatric consultations. Methods: Medical records of the patients who developed this clinical situation observed in psychiatric consultations in the Psychiatry Department of the Prof. Dr. Fernando Fonseca Hospital during the year of 2017 were analyzed, complemented with a non-systematic review of the literature. Results: The case reports consider two women who developed prolactin-related symptoms after the initiation of olanzapine. No baseline prolactinemia was obtained, and prolactin serum levels were only evaluated after prolactin-related symptoms developed: at the time of its measurement, both patients had been taking olanzapine for more than 24 weeks. Hyperprolactinemia was found to be present in Case 2, whereas Case 1 (a 49-year-old woman) had “normal” serum prolactin levels for premenopausal and prolactin levels slightly above the maximum levels for postmenopausal women. Both patients underwent similar pharmacological adjustments, which comprised switches from olanzapine to aripiprazole. After all pharmacological changes, prolactin serum levels decreased to normal range values and prolactin-related symptoms disappeared. Discussion/Conclusions: Laboratorial and literature prolactinemia values variability and discrepancies may make the management of borderline hyperprolactinemia clinical situations difficult. Baseline prolactin levels should have been obtained, as they help in the management of patients who develop neuroleptic-induced hyperprolactinemia. Prolactin-related symptoms can occur with borderline or normal standardized prolactinemia values. Olanzapine-induced hyperprolactinemia is a rare but possible event. Aripiprazole was used as a suitable alternative for olanzapine-induced hyperprolactinemia.

Immunoendocrine Peripheral Effects Induced by Atypical Antipsychotics

“…There are two case reports of women aged 29 and 49 years with bipolar affective disorder and delusional disorder who exhibited HPRL associated with olanzapine consumption during 24 weeks (5-20 mg/day) (201). Most reports evidence the increase of this hormone: A study with 72 patients (33 women and 39 men) who were administered olanzapine (10-20 mg/day) for 3 weeks or more showed an increase in PRL levels only in female patients (202).…”

“…This phenomenon hampers the interaction between DA and its receptor, so DA cannot inhibit PRL production. The alterations depend on gender, genetic predisposition, dose, and time of consumption (115,190,201,205).…”

Integrating machine learning with electronic health record data to facilitate detection of prolactin level and pharmacovigilance signals in olanzapine-treated patients

“…Our work revealed gender-specific differences in these decreased effects (see Figure 5 ). Moreover, as a suitable alternative for OLZ-induced hyperprolactinemia, aripiprazole may not only diminish PRL levels but may also clear PRL-related symptoms that may occur with borderline or normal standardized PRL values while maintaining clinical stabilization ( 76 ). Notably, an abnormally low PRL level after switching to aripiprazole might occur, and this is a potential warning sign of a psychotic rebound.…”

The coexistence of pituitary macroadenoma and schizophrenia – practical therapeutic implications based on the case report and the literature review

“…One of the likely scenarios is that the patient had had persistently high serum prolactin levels, which had probably contributed to the development of pituitary macroadenoma. Olanzapine is an antipsychotic drug that does not significantly affect serum prolactin levels, although cases have been reported in which symptoms related to elevated serum prolactin levels appeared after starting olanzapine treatment (Barata et al, 2019).…”