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| |  ISP: Antipsychotic-Induced Hyperprolactinemia May Have Reproductive And Other Clinical Morbidities By Alison Palkhivala Special to DG News
QUEBEC CITY, QC -- August 8, 2001 -- Treatment with conventional antipsychotics and risperidone may result in increased serum prolactin levels high enough to have important clinical consequences. In particular, researchers say, their effects on female reproduction are a concern. "Clinicians need to be concerned about the fact that antipsychotic drugs can elevate serum prolactin," said Bruce J. Kinon, MD. "As prolactin levels go higher and higher, premenopausal women who should be menstruating [may] … experience cessation of their menses [or other menstrual problems]. "We [also] have data [showing] that men [with high prolactin] experience changes in their reproductive hormones," Dr. Kinon explained. "Just as women achieve a hypogonadal state, … in men we see a reduction in testosterone as prolactin levels become elevated." According to Dr. Kinon, "the drugs that have traditionally been associated with very little elevation of prolactin are clozapine, olanzapine, and quetiapine. The ones that appear to be associated with high elevations are risperidone as well as the older [conventional] antipsychotics." Dr. Kinon, a senior clinical research physician with Eli Lilly and Company in Indianapolis, Indiana, presented these findings in a poster session at the 32nd Annual Meeting of the International Society of Psychoneuroendocrinology taking place this week in Quebec City. Eli Lilly manufacturers of olanzapine, and the research was conducted at their laboratories. Dr. Kinon and colleagues assessed serum prolactin levels of 147 women and 255 men who had been taking a conventional antipsychotic or the atypical antipsychotic risperidone for at least three months for the treatment of a psychotic disorder. None were taking other medications known to elevate prolactin levels. The proportion of pre-, peri-, and postmenopausal women with prolactin levels above normal was 65.6 percent, 100 percent, and 45.1 percent, respectively. Among the men, 42.4 percent had elevated prolactin. Hyperprolactinemia was especially common among those patients taking risperidone. In some individuals, prolactin levels were very high, even two to four times greater than normal levels. Premenopausal women with elevated prolactin leves were more likely to have lower serum estradiol and progesterone as well as higher serum total testosterone. There was also a trend towards a correlation between serum prolactin concentration and menstrual abnormalities, which included amenorrhea, oligomenorrhea, and polymenorrhea. Dr. Kinon and colleagues are also looking into the long-term consequences of hyperprolactinemia. Some of their early findings suggest that it might be associated with a reduction in bone mass and loss of sexual functioning in women.
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