Use of the dopamine agonists bromocriptine and cabergoline in the management of risperidone-induced hyperprolactinemia in patients with psychotic disorders

Abstract

Risperidone is a novel antipsychotic agent that blocks both dopaminergic and serotonergic receptors. In several reports, clinically significant hyperprolactinemia has been reported in patients on this agent. However, the optimal management of risperidone-induced hyperprolactinemia has not been clarified. We reviewed the records of 5 patients with psychotic disorders who were evaluated for risperidone-induced hyperprolactinemia. There were 4 females and 1 male patient, aged 30-45 yr. All patients had significant hyperprolactinemia, with prolactin (PRL) levels ranging from 65.5 to 209 microg/l. All but 1 of these patients had manifestations of hypogonadism. In these 4 patients, risperidone therapy was continued and the dopamine agonists bromocriptine or cabergoline were added. In 3 out of 4 patients, such additional therapy reduced the PRL level and alleviated hypogonadism. None of the patients treated with these agents had a worsening of psychosis. We conclude that risperidone can cause clinically significant hyperprolactinemia in patients treated with this drug. If risperidone therapy must be continued in such patients, addition of the dopamine agonists bromocriptine or cabergoline may successfully alleviate hyperprolactinemia and the associated manifestations without worsening psychotic symptoms.

A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia

“…All of them were short-term and had small sample sizes, as shown in Table 1. [13][14][15][16][17][18][19][20][21][22][23][24][25] Bromocriptine was involved in the treatment of these dysfunctions in two studies, sildenafi l in four, amantadine in two and cyproheptadine, imipramine, shakuyaku-kanzo-to, cabergoline and selegiline in one each.…”

“…Dopamine agonists such as bromocriptine and cabergoline may be successful in reducing the level of hyperprolactinemia and alleviating symptoms in some patients. 15 Previous studies 14 have shown that modest doses of bromocriptine may be safely prescribed to patients taking older fi rst-generation agents, and who have symptomatic hyperprolactinemia without exacerbating psychosis.…”

“…30 A description of the main drugs, respective doses, potential drug interactions and side effects can be found in Table 2. [13][14][15][16][17][18][19][20]23,24,27,[30][31][32][33][34][35][36][37][38] DISCUSSION Sexual performance among patients with schizophrenia may differ from the qualitative and quantitative patterns in the normal population. It may be altered through three main factors: by the disease itself as a consequence of affective and/or cognitive impairment; by antipsychotic drugs; and by other clinical problems (such as diabetes, hypertension, alcohol and drug abuse).…”

Hyperprolactinaemia – Differential Diagnosis, Investigation and Management

“…68 Dopamine agonists are sometimes used, although there are reports that these agents can precipitate psychosis in predisposed patients. [69][70][71][72][73] In subjects not seeking fertility, sex steroid replacement in the form of oestrogen (or testosterone in males) may be appropriate, particularly for women of pre-menopausal age with amenorrhoea. 26 If the patient is largely asymptomatic, no specific treatment may be necessary.…”

Female Sexual Disorders: Psychiatric Aspects

“…Switching from a prolactinelevating antipsychotic to olanzapine has been reported to restore normal sexual function (84). Other clinicians have reported that coadministration of dopamine agonists such as bromocriptine and cabergoline may reverse antipsychoticinduced sexual dysfunction (85,86).…”