Hyperprolactinemia risperidone

Aripiprazole Blockade of 5HT2A receptors > blockade of D2 receptors Some a blockade (clozapine, risperidone, ziprasidone) and M-receptor blockade (clozapine, olanzapine) variable receptor blockade (all) Schizophrenia—improve both positive and negative symptoms bipolar disorder (olanzapine or risperidone adjunctive with lithium) agitation in Alzheimer s and Parkinson s (low doses) major depression (aripiprazole) Toxicity Agranulocytosis (clozapine), diabetes (clozapine, olanzapine), hypercholesterolemia (clozapine, olanzapine), hyperprolactinemia (risperidone), QT prolongation (ziprasidone), weight gain (clozapine, olanzapine)... 

Ari pi prazole, olanzapine, quetiapine, risperidone, and ziprasidone are effective as monotherapy or as add-on therapy to lithium or valproate for acute mania. Prophylactic use of antipsychotics can be needed for some patients with recurrent mania or mixed states, but the risks versus benefits must be weighed in view of long-term side effects (e.g., obesity, type 2 diabetes, hyperlipidemia, hyperprolactinemia, cardiac disease, and tardive dyskinesia). 

All conventional antipsychotic medications and risperidone may cause hyperprolactinemia. Side effects mediated, at least in part, by hyperprolactinemia include gynecomastia, galactorrhea, amenorrhea, and decreased libido. Thioridazine may cause painful retrograde ejaculation. 

Atypical antipsychotics cause fewer EPS than do conventional antipsychotics. Clozapine and quetiapine are the least likely to cause EPS and are therefore recommended for treatment of psychosis in patients with Parkinson s disease. With the notable exception of risperidone, atypical antipsychotics cause substantially less hyperprolactinemia than do conventional antipsychotics. Weight gain is a side effect of all atypical antipsychotics except ziprasidone and aripiprazole. Concerns about cardiac conduction delay with ziprasidone therapy exist and warrant consideration in patients who have... 

Insomnia, hypotension, agitation, headache, and rhinitis are the most common side effects of risperidone. These tend to lessen with time. Overall, the drug tends to be well tolerated. Average weight gain associated with risperidone after 10 weeks of treatment is 2.10 kg (AUison et al. 1999). Risperidone does not have significant anticholinergic side effects. Hyperprolactinemia is common. 

A 35-year-old woman developed hyperprolactinemia, amenorrhea, and galactorrhea after taking risperidone for 2 months the effects persisted after she switched to olanzapine, mean dose 2.5 mg/day (854). 

Improvement in galactorrhea has also been observed in a case of trichotillomania refractory to a selective serotonin reuptake inhibitor (857). The patient only had a positive response with risperidone in combination with fluoxetine, but developed hyperprolactinemia and an intolerable galactorrhea. Olanzapine in combination with fluoxetine was started, with significant clinical improvement and without symptoms of galactorrhea however, the patient had undesired weight gain of 3.6 kg after 22 weeks. 

Five patients (four women and one man, aged 30-45 years), who were evaluated for risperidone-induced hyperprolactinemia, had significant hyperprolactinemia, with prolactin concentrations of 66-209 pig/1 (1017). All but one had manifestations of hypogonadism, and in these four patients, risperidone was continued and a dopamine receptor agonist (bromocriptine or cabergoline) was added in three patients this reduced the prolactin concentration and alleviated the hypogonadism. 

Hyperprolactinemia was found after about 30 months in 12 premenopausal women with schizophrenia or schizoaffective disorder (aged 15-55 years) taking risperidone but not in those taking olanzapine (n = 14) (1030). Prolactin concentrations were significantly higher in the first group than in the second (123 ng/ml versus 26 ng/ml). 

Risperidone-induced hyperprolactinemia has been reported to resolve with quetiapine, a low-potency dopamine D2 receptor antagonist (1037). 

Tollin SR. Use of the dopamine agonists bromocriptine and cabergoline in the management of risperidone-induced hyperprolactinemia in patients with psychotic disorders. J Endocrinol Invest 2000 23(ll) 765-70. 

Kinon BJ, Gilmore JA, Liu H, Halbreich UM. Prevalence of hyperprolactinemia in schizophrenic patients treated with conventional antipsychotic medications or risperidone. Psychoneuroendocrinology 2003 28 55-68. 

Brunelleschi S, Zeppegno P, Risso F, Cattaneo Cl, Torre E. Risperidone-associated hyperprolactinemia evaluation in twenty psychiatric outpatients. Pharmacol Res 2003 48 405-9. 

Kunwar AR, Megna JL. Resolution of risperidone-induced hyperprolactinemia with substitution of quetia-pine. Ann Pharmacother 2003 37 206-8. 

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. 

The risk of prolactinoma in patients taking risperidone and other neuroleptic drugs, accompanied by hyperprolactinemia, amenorrhea, and galactorrhea has been discussed in the light of a case of hyperprolactinemia (160). 

C Risperidone. Although the incidence of adverse effects associated with hyperprolactinemia is rare with atypical antipsychotics, risperidone can inaease prolactin levels in a dose-dependent manner. Blockade of the dopaminergic tone in the hypothalamus and 5HT-2 antagonism by risperidone may explain this effect. Other adverse eff associated with persistent prolactin elevation include sexual dysfunction, female menstrual disorders, and reduced bone mineral density. 

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