Prolactin elevation

Clinical presentation is associated with the degree of prolactin elevation ... 

Nevertheless, some dopamine-blockade side effects can still be found with the atypicals. Prolactin elevation still occurs, particularly with risperidone. The risk of... 

Endocrine Prolactin elevation Dopamine 2 Obtain prolactin level for patients with breast enlargement, menstrual abnormalities, or gynecomastia... 

Pharmacologists have been attempting to define what it is about clozapine s biochemical mechanism of action that accounts for its special efficacy as well as its side effects. As discussed extensively in this chapter, SDA properties may account in part for reducing EPS, for reducing tardive dyskinesia, and perhaps even for lack of prolactin elevation SDA properties may even help explain improvement in negative symptoms of schizophrenia. However, the concept of SDA does not appear to explain the therapeutic actions of clozapine in treatment-resistant cases because clozapine is superior to other agents that share this property. 

Quetiapine also has a chemical structure related to that of clozapine (Fig. 11—36), but it has several differentiating pharmacologic (Fig. 11—41) and clinical features, not only as compared with clozapine (Fig. 11—37) but also as compared with risperidone (Fig. 11-39) and olanzapine (Fig. 11-40). Quetiapine is very atypical in that it causes virtually no EPS at any dose and no prolactin elevations. Thus, quetiapine tends to be the preferred atypical antipsychotic for patients with Parkinson s disease and psychosis. It is also useful in schizophrenia, bipolar disorder, and other types of psychosis, in which it has few extrapyramidal side effects. 

Ziprasidone has a novel chemical structure (Fig. 11—42) and a quite novel pharmacological profile as compared with the other atypical antipsychotics (Fig. 11—43). Ziprasidone appears to be atypical, like the other agents in this class, in that it has low EPS and causes little or no prolactin elevation. Its major differentiating feature... 

To explain why atypical antipsychotics have fewer extrapyramidal side effects, less tardive dyskinesia, less prolactin elevation and better improvement of negative and cognitive symptoms of schizophrenia compared to conventional antipsychotics. 

Peterson MC. Reversible galactorrhea and prolactin elevation related to fluoxetine use. Mayo Clin Proc 2001 76(2) 215-6. 

Melkersson KI, Hulting AL, Rane AJ. Dose requirement and prolactin elevation of antipsychotics in male and... 

Popli A, Gupta S, Rangwani SR. Risperidone-induced galactorrhea associated with a prolactin elevation. Ann Clin Psychiatry 1998 10(l) 31-3. 

From the perspective of tolerability, these new atypicals are clearly superior to conventionals. The rates of extrapyramidal symptoms, tardive dyskinesia, and anticholinergic effects are much lower. Flowever, as their use has become more commonplace, these drugs appear to have their own adverse effects, some of which have raised substantial concerns. They include increased rates of extrapyramidal symptoms at higher than usual doses, prolactin elevations, and electrocardiogram changes. 

Compared to other atypical antipsychotics with potent serotonin 2A antagonism, amisulpride may have more extrapyramidal symptoms and prolactin elevation, but may still be classified as an atypical antipsychotic, particularly at low doses... 

Little or no prolactin elevation, motor side effects, or tardive dyskinesia... 

Developed as a conventional antipsychotic i.e., reduces positive symptoms, but causes extrapyramidal symptoms and prolactin elevations... 

Patients who are sensitive to the prolactin-elevating properties of other SSRis (sertraline is the one SSRI that generally does not elevate prolactin)... 

Prolactin elevation. Classical antipsychotics raise plasma prolactin concentrations by their blocking action on dopamine receptors in the tuberoinfundi-bular pathway (Fig. 19.3 and p. 711) and can cause... 

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. 

Quetiapine has sedative effects and may cause weight gain, bnt it causes minimal extrapyramidal side effects or prolactin elevations. Ziprasidone canses few extrapyramidal side effects, does not significantly increase prolactin levels, and has a lower risk of causing weight gain. Aripiprazole has low extrapyramidal side effects (except for initial akathisia), minimal effect on prolactin levels, and is considered to be weight neutral. 

Hyperprolactinemia is a state of persistent serum prolactin elevation. Prolactin concentrations greater than 20 mcg/L observed on multiple occasions are generally considered indicative of hyperprolactinemia. " Hyperprolactinemia usually affects women of reproductive age. " The incidence of hyperprolactinemia in the general population is reported to be less than 1%. ... 

Hyperprolactinemia—A state of persistent serum prolactin elevation characterized by prolactin concenhations greater than 20 micro-grams/Uter observed on multiple occasions. 

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