Antipsychotic‐Induced Hyperprolactinemia

Abstract

Use of antipsychotic agents has been associated with hyperprolactinemia, or elevated prolactin levels; this hormonal abnormality can interfere with the functioning of reproductive, endocrine, and metabolic systems. As antipsychotic agents are increasingly used for both United States Food and Drug Administration-approved and nonapproved indications, many individuals are at risk for developing antipsychotic-induced hyperprolactinemia. First-generation antipsychotics pose the greatest risk of causing this adverse effect; however, second-generation antipsychotics, particularly risperidone and paliperidone, also often increase prolactin secretion. Hyperprolactinemia has short- and long-term consequences that can seriously affect quality of life: menstrual disturbances, galactorrhea, sexual dysfunction, gynecomastia, infertility, decreased bone mineral density, and breast cancer. Although many of these are definitively connected to elevated prolactin levels, some, such as breast cancer, require further study. Both clinicians and patients should be aware of hyperprolactinemia-associated effects. To prevent or alleviate the condition, tailoring an antipsychotic drug regimen to each individual patient is essential. In addition, the risk of hyperprolactinemia can be minimized by using the lowest effective dose of the antipsychotic agent. If the effects of prolactin are evident, the drug can be changed to another agent that is less likely to affect prolactin levels; alternatively, a dopamine agonist may be added, although this may compromise antipsychotic efficacy. Additional research is needed to clarify the appropriate level of monitoring, the long-term effects, and the optimal treatment of antipsychotic-induced hyperprolactinemia.

Mammary gland serotonin regulates parathyroid hormone-related protein and other bone-related signals

“…Enhanced 5-HT bioactivity leading to local PTHrP secretion may be one mechanism involved in bone loss caused by these drugs. In addition, antidepressant and antipsychotic drugs tend to cause hyperprolactinemia, and the degree of hyperprolactinemia can be substantial (4,33). Demineralization of the bones is also commonly associated with hyperprolactinemia resulting from prolactinomas (12,27,44,48).…”

Psychiatric Patients with Antipsychotic Drug-Induced Hyperprolactinemia and Menstruation Disorders

“…Bostwick et al reported that if the effects of PRL are evident, the drug can be changed to another agent that is less likely to affect PRL levels. 17) Further research is needed to clarify the appropriate method for PRL monitoring. In the present study, using ROC curve analysis, we estimated that the cutoff value of PRL that can lead to adverse side effects induced by antipsychotic drugs, such as menstrual disorders, was 60 ng/mL.…”

Doctors' understanding of antipsychotic associated hyperprolactinaemia

“…9 One treatment option is reducing the dose of the antipsychotic but some do not recommend this as first-line treatment as this may reduce therapeutic efficacy and may also fail to reduce prolactin levels sufficiently. 4,10 The literature generally suggests that the first step in active management would be to switch to an antipsychotic not associated with prolactin elevation. [2][3][4]7,9,10 For some patients, however, switching drugs is not an option, for example, for those on a depot preparation where compliance is an issue or in patients in whom the risk of relapse is too great.…”