Psychopharmacology - Antipsychotic - AP induced Hyperprolactinemia
3 important questions on Psychopharmacology - Antipsychotic - AP induced Hyperprolactinemia
How dose AP cause hyperprolactinemia
Dopamine inhibit prolactin release and dopamine antagonists can be expected to increase prolactin plasma level.
The degree of increase prolactin plasma level is probably dose-related, D2-occupancy of the antipsychotic medication and genetic differences.
The degree of increase prolactin plasma level is probably dose-related, D2-occupancy of the antipsychotic medication and genetic differences.
Clinical Picture of AP induced hyperprolactinemia
Commonly asymptomatic
Symptoms
Sexual dysfunction, menstrual disturbances, breast growth and galactorrhoea and may include delusion of pregnancy
Long term
reductions in bone mineral density, possible increase in the risk of breast cancer.
Symptoms
Sexual dysfunction, menstrual disturbances, breast growth and galactorrhoea and may include delusion of pregnancy
Long term
reductions in bone mineral density, possible increase in the risk of breast cancer.
How to manage AP induced Hyperprolactinemia
· Switching to antipsychotic with lower liability for prolactin elevation is usually the first chose but it carries risk of destabilization the illness and relapse.
· aripriprazole to existing treatment. Aripriprazole reduce prolactin level in dose-dependent manner: 3mg/day is effective.
· dopamine agonist can be effective e.g Amatadine, Cabergoline and bromocriptine
· Other strategies to reduce long term risk to bone mineral density should be discussed e.g stop smoking, increase weight bearing exercise, and ensuring adequate calcium and Vit D3 intake.
· A reduction of prolactin level by high dose of metformin in diabetic women on antipsychotic medication.
· aripriprazole to existing treatment. Aripriprazole reduce prolactin level in dose-dependent manner: 3mg/day is effective.
· dopamine agonist can be effective e.g Amatadine, Cabergoline and bromocriptine
· Other strategies to reduce long term risk to bone mineral density should be discussed e.g stop smoking, increase weight bearing exercise, and ensuring adequate calcium and Vit D3 intake.
· A reduction of prolactin level by high dose of metformin in diabetic women on antipsychotic medication.
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