Antipsychotics and prolactinemia: biological regulation and clinical aspects

Antipsicotici e prolattinemia: regolazione biologica e aspetti clinici

W. Milano, M. De Rosa, L. Milano, G. Nolfe, C. Petrella

Operative Unit for Mental Health, 24 ASL Naples 1


A number of antipsychotics, including oral haloperidol, amisulpride and risperidone, are associated with hyperprolactinemia, an adverse effect that is not related to their therapeutic efficacy. This adverse reaction not only has a negative impact on sexual and reproductive function in the short-term, but also produces body weight gain and reduction in bone density, leading in the long-term to obesity, a condition that notoriously increases the risk of a broad range of medical disorders, as well as all-cause mortality, and to osteoporosis, which notoriously increases the risk of fractures and chronic disability. Other long-term adverse effects of hyperprolactinemia include an increase in the risk of breast and endometrial cancer (Table II).

Prolactin levels should be monitored in patients on long-term antipsychotic treatment and early signs heralding the development of hyperprolactinemia, such as body weight gain and menstrual changes, should be sought regularly.

Four therapeutic options are available for management: reduction in the dosage of the prolactin-raising agent; switch to a prolactin-sparing agent, such as aripiprazole, clozapine, quetiapine or olanzapine; addition of a dopamine agonist or of hormonal therapy with estrogens and progestogens. None of these options is ideal and preventive measures tailored to the needs of the individual patient are to be preferred.

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