How is hyperprolactinaemia related to schizophrenia?

One potential side effect of antipsychotic use hyperprolactinemia, which can disrupt sex hormones and the production and flow of breast milk, and can cause infertility and erectile dysfunction in men. Hyperprolactinemia is caused by blocking of the D2 dopamine receptor at the anterior lobe of the pituitary gland, resulting in high prolactin levels. As different antipsychotics have different actions, they also differ in the degree to which they affect prolactin levels.

What is the evidence for hyperprolactinaemia?

High quality evidence shows large increases with prolactin levels were found with risperidone and paliperidone when compared to placebo. Medium-sized effects were found with sertindole and haloperidol, and small increases in prolactin concentrations with ziprasidone and lurasidone. No differences in prolactin levels were found between placebo and aripiprazole, quetiapine, asenapine, chlorpromazine, and iloperidone. Moderate to low quality evidence suggests hyperprolactinaemia may also be associated with amisulpride.

For children and adolescents with schizophrenia, moderate to low quality evidence found a large effect of increased prolactin levels with risperidone compared to placebo, medium-sized effects of increased prolactin levels with olanzapine and paliperidione compared to placebo, and a small effect of decreased prolactin with aripiprazole compared to placebo. Similarly, indirect comparisons between antipsychotics in children and adolescents found greater prolactin increases with risperidone when compared to aripiprazole, molindone, quetiapine, olanzapine and paliperidone; greater increases with paliperidone compared to aripiprazole and quetiapine; and greater increases with olanzapine compared to aripiprazole.

March 2019

Last updated at: 1:27 am, 21st March 2019
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