Management of antipsychotic-induced hyperprolactinemia

Abstract

Introduction:Antipsychotics represent a large portion of the psychotropics that may induce hyperprolactinemia. Clinical psychiatric pharmacists must be adept in stratifying the relative risk of hyperprolactinemia among psychotropics, identifying patient risk factors, recognizing differential diagnoses, and recommending therapeutic alternatives and treatment strategies. High-potency, typical antipsychotics are more likely to elevate prolactin although exceptions to the rule exist.Methods:A literature search of PubMed and Google Scholar was performed to identify English language articles on the treatment of antipsychotic-induced hyperprolactinemia in humans. Methodological rigor is summarized for compiled studies in addition to feasibility and limitations of application to clinical practice.Results:There is an absence of robust evidence for the management of antipsychotic-induced hyperprolactinemia. Among the pharmacological treatments studied, aripiprazole (switching or augmentation) possessed the strongest evidence. Pharmacological treatments with less evidence encompassed dose reduction, switching to lower potency antipsychotics, and adding dopamine agonists. To date, no head-to-head studies have been published on the above approaches.Discussion:Atypical antipsychotics with low affinity for dopamine (D2) receptors, such as olanzapine, are logical alternatives for the patient experiencing drug-induced hyperprolactinemia. When augmentation is clinically preferred to switching, a viable option is the addition of a full or partial dopamine agonist, such as bromocriptine or aripiprazole, respectively. Patient-specific risk of psychiatric decompensation and the severity of symptomatic hyperprolactinemia should be weighed when formulating treatment strategies.

Effects of aripiprazole on circadian prolactin secretion related to pharmacogenetics in healthy volunteers

“…If this is not viable, the dose could be reduced; the clinician could switch to another antipsychotic—the most recommended drug is aripiprazole—or could use a full or partial dopamine agonist. However, before switching to another drug, healthcare practitioners must weigh the risks of psychiatrically stable patients having a relapse due to changing or experiencing additional intolerable adverse effects . Measuring prolactin concentrations is already introduced to clinical practice after starting treatment with a new antipsychotic.…”

“…However, before switching to another drug, healthcare practitioners must weigh the risks of psychiatrically stable patients having a relapse due to changing or experiencing additional intolerable adverse effects. 47 Measuring prolactin concentrations is already introduced to clinical practice after starting treatment with a new antipsychotic. However, none of the available guidelines advocate a routine baseline plasma prolactin level measurement 48 what we suggest in our study.…”

Crippling Side Effects Induced by Paliperidone Palmitate Treatment: A Case Report

“…Risperidone and paliperidone palmitate, second-generation antipsychotics, have been linked with elevated serum prolactin levels [ 17 ]. In addition, women of reproductive age have been found to exhibit a greater risk of developing hyperprolactinemia [ 18 ].…”

<p>A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future</p>

“…Several studies have subsequently confirmed a favorable impact of olanzapine on prolactin levels 98–100. As a result, patients taking olanzapine may be at reduced risk for complications of hyperprolactinemia, including gynecomastia, galactorrhea, menstrual irregularities, and sexual dysfunction, compared with other antipsychotics 101. Lastly, olanzapine treatment was associated with a low incidence of seizures, 22/2500 (0.9%), during premarketing studies 1.…”