Galactorrhea risperidone

In the second study, which lasted 2 years, long-acting injectable risperidone (n = 50) was compared with oral risperidone (n = 47) and haloperidol (n = 47) [130. Prolactin-related adverse events occurred in four of those who received injectable risperidone galactorrhea in one amenorrhea... 

Antipsychotic-induced elevations in prolactin levels with associated galactorrhea and menstrual irregularities are common. These effects may be dose related and are more common with the use of FGAs and risperidone. 

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. 

A number of antidepressant drugs, particularly SSRIs, can increase plasma prolactin concentrations, although galactorrhea is uncommon. In a prescription event monitoring survey of about 65 000 patients, compared with SSRIs, moclobemide was associated with a relative risk of galactorrhea of 6.7 (95% Cl = 2.7, 15) (727). However, this was substantially less than the risk associated with the dopamine receptor antagonist risperidone (relative risk compared with SSRIs 32 95% Cl = 14, 70). 

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. 

The relation of prolactin concentrations and certain adverse events has been explored by using data from two large randomized, double-blind studies (n = 2725 813 women, 1912 men) (1018). Both risperidone and haloperidol produced dose-related increases in plasma prolactin concentrations in men and women, but they were not correlated with adverse events such as amenorrhea, galactorrhea, or reduced libido in women or with erectile dysfunction, ejaculatory dysfunction, gynecomastia, or reduced libido in men. Nevertheless, in five patients risperidone (1-8 mg/day) caused amenorrhea in association with raised serum prolactin concentrations (mean 122 ng/ml, range 61-230 ng/ml reference range 2.7-20 ng/ml) (1019). 

Furthermore, risperidone-induced galactorrhea associated with a raised prolactin has been reported (1020,1021), as have amenorrhea and sexual dysfunction (1022). 

Galactorrhea associated with a rise in prolactin occurred after a few weeks of treatment with risperidone in two women aged 24 and 39 (1021). One of them was switched to thioridazine, with an improvement in the galactorrhea, and the other continued to take risperidone owing to a robust response her galactorrhea was partially treated with bromocriptine. 

Galactorrhea and gynecomastia occurred in a 38-year-old hypothyroid man who took risperidone for 14 days (1024). 

A 17-year-old man developed galactorrhea and breast tenderness within weeks of starting to take risperidone. 

A 35-year-old woman who had taken lithium carbonate 800 mg/day for 2 years was also given risperidone 6 mg/ day for a manic relapse. She missed two menstrual periods and had galactorrhea. A head CT scan showed a pituitary microadenoma and the prolactin concentration was 125 pig/l (reference range up to 20 pg/1). Risperidone withdrawal resulted in disappearance of the prolactinoma. Her other symptoms persisted and did not change with olanzapine 2.5 mg/day however, bromocriptine 12.5 mg/day for 2 weeks relieved her symptoms and the prolactin concentration normalized. 

Galactorrhea has been reported in relation to risperidone (SEDA-25, 69 SEDA-26, 65 SEDA-27, 63), and four new cases have been published (1036). It is suggested that this condition can occur after many weeks of risperidone treatment, with small dosages (2-4 mg/day), and at times even after drug withdrawal. 

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

Schreiber S, Segman RH. Risperidone-induced galactorrhea. Psychopharmacology (Berl) 1997 130(3) 300-1. 

Mabini R, Wergowske G, Baker FM. Galactorrhea and gynecomastia in a hypothyroid male being treated with risperidone. Psychiatr Serv 2000 51(8) 983-5. 

Gupta S, Frank B, Madhusoodanan S. Risperidone-associated galactorrhea in a male teenager. J Am Acad Child Adolesc Psychiatry 2001 40(5) 504-5. 

In an 8-week open prospective study of risperidone in 20 patients, mean age 34 (range 19-53) years, adverse effects included giddiness (n = 3), headache (n = 2), and agitation (n = 2) one woman reported galactorrhea and another developed obsessive-compulsive symptoms 16 of 20 patients were taking antiparkinsonian drugs before the study, compared with 12 patients at the end (10). 

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). 

The transfer to milk of risperidone and its active metabolite 9-hydroxyrisperidone has been examined in two breast-feeding women and in one woman with risperidone-induced galactorrhea (209). The milkrplasma concentration ratio was under 0.5 for both compounds the calculated relative infant doses were 2.3%, 2.8%, and 4.7% of that of women s weight-adjusted doses neither compound was detected in the plasma of the two babies, who achieved their developmental milestones satisfactorily and did not have any adverse effect attributable to risperidone. The authors concluded that maternal risperidone therapy is unlikely to pose a significant hazard to the breast-fed infant in the short term, and recommended an individual benefit-harm analysis to take decisions about this issue. 

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