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Psychotropic-induced hyperprolactinemia: a clinical review
Adnan Ajmal1, Hadine Joffe2, Lisa B Nachtigall1
1Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Psychosomatics
|October 22, 2013
Summary
Psychotropic medications can cause hyperprolactinemia, leading to hypogonadism and bone loss. Evaluating and managing elevated prolactin levels, potentially with prolactin-sparing antipsychotics like aripiprazole, is crucial for patient health.
Area of Science:
- Endocrinology
- Psychiatry
- Pharmacology
Background:
- Psychotropic medications, especially certain antipsychotics, are frequent causes of drug-induced hyperprolactinemia.
- Elevated prolactin levels can lead to hypogonadism, reproductive issues, and bone density loss, necessitating recognition and management.
Purpose of the Study:
- To review the causes, signs, and symptoms of hyperprolactinemia.
- To elucidate the mechanisms by which psychotropic drugs elevate prolactin.
- To propose an evidence-based management strategy for psychotropic-induced hyperprolactinemia.
Main Methods:
- A comprehensive PubMed/MEDLINE search was performed.
- Included studies focused on psychotropic agents as a cause of hyperprolactinemia.
- Prioritized material relevant to current psychiatric practice and high levels of evidence.
Main Results:
- Hyperprolactinemia evaluation is recommended for adult patients on psychotropic agents exhibiting related signs and symptoms.
- Magnetic resonance imaging (MRI) is advised to rule out pituitary/hypothalamic disease if the cause is uncertain.
- Bone mineral density (BMD) assessment is important for patients with persistent hyperprolactinemia and reproductive dysfunction due to potential bone loss.
Conclusions:
- Consider aripiprazole or other prolactin-sparing atypical antipsychotics as alternatives.
- Aripiprazole may be used as adjunctive therapy in specific cases of drug-induced hyperprolactinemia.
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