Management of antipsychotic-induced hyperprolactinaemia

Abstract

SummaryHyperprolactinaemia is a common endocrine disorder that can be associated with significant morbidity. Antipsychotic medications are frequently linked to hyperprolactinaemia. This disorder usually presents as menstrual problems in women and sexual problems in men, which affect the patients' quality of life and adherence to antipsychotic treatment. In the past, treatment for hyperprolactinaemia was recommended only for symptomatic patients. However, it has become clear that persistent asymptomatic hyperprolactinaemia can be associated with long-term physical morbidities such as osteoporosis and possibly breast cancer. Hence, it is imperative that hyperprolactinaemia is managed even if asymptomatic when initially detected. This article discusses the various management options, such as reducing the dose of antipsychotic medication, switching to a prolactin-sparing antipsychotic and adding aripiprazole to the treatment regimen.Learning Objectives• Understand the physiology of the prolactin hormone• Be able to judge when to intervene if a patient on an antipsychotic medication presents with hyperprolactinaemia• Learn about the different treatment options

Aripiprazole-induced Diplopia: A Rare Case Report

“…2 It also indicated a low incidence of weight gain and a low liability for inducing movement disorders. 3 Other early data suggest that aripiprazole may induce reductions in plasma prolactin 4 as well as in plasma glucose and lipid profiles. Ocular side effects from aripiprazole are very rare; and till date, eight cases of transient myopia related to aripiprazole were reported 5 and only two previously reported cases of aripiprazole-induced diplopia.…”

Prolactin monitoring in schizophrenia should be indicated by symptomatology not time

“…Recently, Gupta et al (2017) noted that currently no consensus exists regarding the routine monitoring of prolactin levels in antipsychotic therapy. Rather they noted most guidelines do not endorse the routine monitoring of prolactin in patients undergoing antipsychotic treatment (Gupta et al, 2017). Specifically, the NICE guidelines advocate baseline measurement of prolactin levels with no follow-up measurement specified (Gupta et al, 2017).…”

“…Rather they noted most guidelines do not endorse the routine monitoring of prolactin in patients undergoing antipsychotic treatment (Gupta et al, 2017). Specifically, the NICE guidelines advocate baseline measurement of prolactin levels with no follow-up measurement specified (Gupta et al, 2017). Thus, time and resources could be better utilized; rather a thorough history should be taken specifically probing for any possible symptoms of hyperprolactinemia with a focus upon symptoms that are under-reported due to their nature specifically, sexual symptoms (Ajmal et al, 2014).…”

“…It should be noted that hyperprolactinemia and the associated symptomatology are distinct between the sexes (Ajmal et al, 2014). However, younger females are at an increased risk in comparison with older males (Gupta et al, 2017).…”

“…Thus, time and resources could be better utilized; rather a thorough history should be taken specifically probing for any possible symptoms of hyperprolactinemia with a focus upon symptoms that are under-reported due to their nature specifically, sexual symptoms (Ajmal et al, 2014). Structured questionnaires are available for the assessment of sexual symptoms to assist patients in divulging information that may make them feel uncomfortable and embarrassed (Gupta et al, 2017).…”