CNS Drugs

, Volume 10, Issue 3, pp 209–222 | Cite as

Hyperprolactinaemia in Antipsychotic-Treated Patients

Adverse Effects

Abstract

Elevated prolactin (PRL) levels have been considered virtually unavoidable in most patients treated with therapeutic doses of traditional antipsychotics. Clinical effects of such hyperprolactinaemia may include amenorrhoea, galactorrhoea and sexual dysfunction. For clinical symptoms, the management has involved minimising the dosage or the use of a PRL-lowering agent.

A number of criteria have been advanced to define the novel or ‘atypical’ antipsychotic agents. These include a lower propensity to induce extrapyramidal adverse effects, improved efficacy against negative symptoms and treatment-resistant schizophrenia, and no sustained, or a lesser, effect on PRL levels. The new antipsychotics are less likely to produce a sustained elevation of PRL levels and therefore offer potential options in the treatment of patients with antipsychotic-induced hyperprolactinaemia.

This article compares data from preclinical and clinical studies of the effects of these newer agents on plasma PRL levels (PRLP). There is clear evidence that PRL release from the pituitary is regulated by dopamine, with more recent findings suggesting that serotonin (5-hydroxytryptamine; 5-HT), vasoactive intestinal peptide (VIP) and some other neurotransmitters also affect the release of PRL. Hyperprolactinaemia (>20 μg/L) is a well known effect of traditional antipsychotic medications due to dopamine receptor antagonism. Clinical symptoms of hyperprolactinaemia may include amenorrhoea, galactorrhoea, sexual dysfunction, infertility, obesity and hirsutism. Certain of the novel antipsychotics including clozapine, quetiapine and possibly sertindole, have little or no effect on PRL secretion and do not cause hyperprolactinaemia or the associated clinical symptoms. Risperidone and possibly olanzapine and ziprasidone appear to cause some dose-related PRL elevation, especially early in the course of treatment. However, the clinical significance is unclear especially if appropriate therapeutic doses are used. Novel antipsychotics offer a distinct advantage over the traditional compounds with regard to PRL release and should be the treatment of choice for patients in whom hyperprolactinaemia is contraindicated.

Keywords

Adis International Limited Haloperidol Clozapine Risperidone Olanzapine 

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Copyright information

© Adis International Limited 1998

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesMedical University of South Carolina, and the Ralph H. Johnson Department of Veterans Affairs Medical CenterCharlestonUSA

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