Amenorrhoea - consequence of combined treatment with sulpiride and risperidone in a patient suffering from schizophrenia

It is well documented that sulpiride causes hormonal adverse events, like amenorrhoea and galactorrhea, due to its mechanism of action. Furthermore, risperidone can produce amenorrhoea and galactorrhea also, due to its mechanism of action, which differs from that of sulpiride. This case report is of a patient that was treated with large doses of sulpiride, but did not develop an adverse event like amenorrhoea. However, when risperidone was introduced into therapy it leads to the onset of amenorrhoea. Gynecologist saw it as the beginning of menopause. General practitioner questioned the existence of an intra-cerebral process that could produce amenorrhoea as well. Therefore, the patient was sent to perform an MRI of the brain, under work diagnosis of pituitary adenoma, which was later ruled out as a cause of the illness. Well experienced psychiatrist linked the loss of menstruation with the adverse event profile of sulpiride and therefore gradually discontinued sulpiride from therapy, while risperidone was left and subsequently menstrual cycle was restored. Good knowledge of adverse events profile of antipsychotic medication used, especially when used in a combination, allows us to correctly question appearance of adverse events, to adequately treat them and lowers the cost of unneeded medical procedures.