Hyperprolactinemia antipsychotic drugs

Angiotensin converting enzyme inhibitors angioedema (Chapter 20) Angiotensin II receptor antagonists angioedema (Chapter 20) Antipsychotic drugs hyperprolactinemia (Chapter 6)... 

Hyperprolactinemia Antipsychotic drugs elevate prolactin levels the elevation persists during chronic administration. 

Dopaminergic projections from the hypothalamus to the pituitary gland tonically inhibit the production and release of prolactin via D2 receptors. The blockade of these receptors leads to hyperprolactinemia, a common side effect of compounds such as typical antipsychotic drugs. 

Serotonin pathways are involved in the regulation of prolactin secretion. Amenorrhea, galactorrhea, and hyperprolactinemia have been reported in a patient who was already taking an antipsychotic drug after starting treatment with fluvoxamine (SEDA-17, 20). 

The relation between antipsychotic drug-induced hyperprolactinemia and hypoestrogenism has been studied in 75 women with schizophrenia (762). Serum estradiol concentrations were generally reduced during the entire menstrual cycle compared with reference values. There was hypoestrogenism, defined as serum estradiol concentrations below 30 pg/ml in the follicular phase and below 100 pg/ml in the periovulatory phase, in about 60%. 

The authors suggested that olanzapine may offer advantages for selected patients in whom hyperprolactinemia occurs during treatment with other antipsychotic drugs. 

In one study, the prevalence of hyperprolactinemia among women taking risperidone was 88% (n = 42) versus 48% (n = 105) in those taking conventional antipsychotic drugs 48% of these women of reproductive age taking risperidone had abnormal menstrual cycles (137). In the whole sample (147 women and 255 men) there were trends towards low concentrations of reproductive hormones associated with rises in prolactin patients taking concomitant medications known to increase prolactin had been excluded. Raised prolactin concentrations were also observed in 13 (9 women and 4 men) of 20 patients (13 women and 7 men mean age 36 years) (138). In premenopausal women there was a good correlation between prolactin concentrations and age, but there was no clear correlation between duration of treatment, dose, prolactin concentration, and prolactin-related adverse effects. 

Phenothiazine antipsychotic drug prototype blocks most dopamine receptors in the CNS. Tox atropine-like, EPS dysfunction, hyperprolactinemia, postural hypotension, sedation, seizures (in overdose), additive effects with other CNS depressants. 

Endocrine A raised prolactin concentration occurs not uncommonly as an adverse effect of antipsychotic drugs but is less often associated with antidepressants. In a comprehensive review of case reports and prospective and retrospective studies, it was documented that all antidepressant classes, except mirtazapine, have been reported to cause hyperprolactinemia [2 ]. However, the findings were mostly derived from case reports and were inconsistent for individual agents within each antidepressant class. 

Aripiprazole for 8 weeks has been used in 24 patients with hyperprolactinemia induced by risperidone, amisulpride, or sulpiride [132 ]. Prolactin concentrations fell from 77 to 18 ng/ml in those taking risperidone, from 145 to 128 in those taking amisulpride, and from 71 to 43 ng/ml in those taking sulpiride. Aripiprazole had no significant effect on metabolic measures or scales of movement adverse reactions. Nevertheless, it should be remembered that antipsychotic drug combinations are not approved for any indication. 

CarroU RW, Christodoulou P, Baynes KC, Kahn DA. Hyperprolactinemia in a patient with a pituitary adenoma receiving antipsychotic drug therapy. J Psychiatr Pract 2012 18(2) 126-9. 

---