1
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Junqueira DR, Bennett D, Huh SY, Casañas I Comabella C. Clinical Presentations of Drug-Induced Hyperprolactinaemia: A Literature Review. Pharmaceut Med 2023; 37:153-166. [PMID: 36800148 PMCID: PMC10097739 DOI: 10.1007/s40290-023-00462-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 02/18/2023]
Abstract
Screening for drug-induced hyperprolactinaemia, a condition characterised by higher-than-normal levels of serum prolactin induced by drug treatments, requires a comprehensive understanding of the clinical presentations and long-term complications of the condition. Using two databases, Embase and MEDLINE, we summarised the available evidence on the clinical presentations and long-term complications of drug-induced hyperprolactinaemia. Clinical and observational studies reporting on drug treatments known or suspected to induce hyperprolactinaemia were included. Database searches were limited to the English language; no date or geographic restrictions were applied. Fifty studies were identified for inclusion, comprising a variety of study designs and patient populations. Most data were reported in patients treated with antipsychotics, but symptoms were also described among patients receiving other drugs, such as prokinetic drugs and antidepressants. Notably, the diagnosis of drug-induced hyperprolactinaemia varied across studies since a standard definition of elevated prolactin levels was not consistently applied. Frequent clinical presentations of hyperprolactinaemia were menstrual cycle bleeding, breast or lactation disorders, and sexual dysfunctions, described in 80% (40/50), 74% (37/50), and 42% (21/50) of the included studies, respectively. In the few studies reporting such symptoms, the prevalence of vaginal dryness impacted up to 53% of females, and infertility in both sexes ranged from 15 to 31%. Clinicians should be aware of these symptoms related to drug-induced hyperprolactinaemia when treating patients with drugs that can alter prolactin levels. Future research should explore the long-term complications of drug-induced hyperprolactinaemia and apply accepted thresholds of elevated prolactin levels (i.e., 20 ng/mL for males and 25 ng/mL for females) to diagnose hyperprolactinaemia as a drug-induced adverse event.Trial Registration PROSPERO International Prospective Register Of Systematic Reviews (CRD42021245259).
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Affiliation(s)
| | - Dimitri Bennett
- Takeda Development Center Americas, Inc., Cambridge, MA, USA. .,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Susanna Y Huh
- Takeda Development Center Americas, Inc., Cambridge, MA, USA.,Ironwood Pharmaceuticals, Boston, MA, USA
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2
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Martínez-Giner G, Giménez-De Llano E, Romero-Rubio D, Abad-Pérez MJ, Sánchez-Martínez V. Sexual dysfunction in people treated with long-acting injectable antipsychotics in monotherapy or polypharmacy: a naturalistic study. Int J Ment Health Nurs 2022; 31:576-590. [PMID: 34973049 DOI: 10.1111/inm.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/22/2021] [Accepted: 12/12/2021] [Indexed: 01/28/2023]
Abstract
Sexual dysfunction, psychosis, and antipsychotics are known to be related, but the precise association between them is still unknown. Most evidence about the prevalence of sexual dysfunction in people treated with antipsychotic drugs comes from studies with restrictive samples. That is why our main objective was to determine the prevalence of sexual dysfunction in a real-life sample of outpatients treated with antipsychotics, considering gender. A cross-sectional naturalistic study was developed, including people treated with long-acting injectable antipsychotics, with or without other psychotropic drugs. Participants were interviewed to assess sexual satisfaction through a Likert scale (0 to 10) and the presence of sexual dysfunction (the Psychotropic-Related Sexual Dysfunction Questionnaire, PRSexDQ-SALSEX). The participants also had a blood test to determine prolactin (men and women) and testosterone levels (men only). A total of 131 people participated in the study (90 men and 41 women). Some extent of sexual dysfunction was found in 62.2% of men and 51.2% of women. The most frequent sexual dysfunction symptom for both genders was the loss of libido (45%). Hyperprolactinemia was present in 56% of men and 61% of women. The presence of sexual dysfunction was associated with higher doses of antipsychotics, hyperprolactinemia, and smoking in men and with smoking and hyperprolactinemia in postmenopausal women. This study provides real-life evidence of sexual dysfunction and hyperprolactinemia in persons treated with long-acting injectable antipsychotics segregated by gender. The high rates of sexual dysfunction and hyperprolactinemia detected corroborate the need to consider these aspects in clinical practice.
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3
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Zhenhua W, Haizhi C, Jing L, Xiaocong F, Jianhua L, Jianjun L, Lilei L, Haiying J. Occurrence of macroprolactinemia in schizophrenia patients treated with risperidone or amisulpride. Asia Pac Psychiatry 2022; 14:e12469. [PMID: 33754473 DOI: 10.1111/appy.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate macroprolactinemia caused by antipsychotics and its clinical significance. METHODS A total of 133 patients with schizophrenia were selected, all of whom were treated with either risperidone or amisulpride alone. The levels of total prolactin (T-PRL) and macroprolactin (MPRL) were measured before treatment as well as the second, fourth, and sixth weeks of treatment. RESULTS After 2 weeks of treatment, 75.09% (100/133) of the patients met the diagnostic criteria for hyperprolactinemia, the incidence of macroprolactinemia was 43% (43/100), and MPRL levels were positively correlated T-PRL levels. CONCLUSION Risperidone and amisulpride caused hyperprolactinemia and macroprolactinemia; thus, detection of MPRL in the clinical setting should be performed as this phenomenon appears early in treatment (the second week) and continues, that can avoid unnecessary examination and treatment for asymptomatic patients with macroprolactinemia.
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Affiliation(s)
- Wang Zhenhua
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Chen Haizhi
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Li Jing
- The Center for Disease Control and Prevention of Huzhou City, Zhejiang, China
| | - Fei Xiaocong
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Li Jianhua
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Liu Jianjun
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Lei Lilei
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
| | - Jin Haiying
- Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Zhejiang, China
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Rahman T, Sahrmann JM, Olsen MA, Nickel KB, Miller JP, Ma C, Grucza RA. Risk of Breast Cancer With Prolactin Elevating Antipsychotic Drugs: An Observational Study of US Women (Ages 18-64 Years). J Clin Psychopharmacol 2022; 42:7-16. [PMID: 34864772 PMCID: PMC8688205 DOI: 10.1097/jcp.0000000000001513] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE/BACKGROUND Antipsychotic drugs are well established to alter circulating prolactin levels by blocking dopamine D2 receptors in the pituitary. Prolactin activates many genes important in the development of breast cancer. Prior studies have found an association with antipsychotic use and risk of breast cancer. METHODS/PROCEDURES The IBM MarketScan Commercial and Medicaid Databases were used to establish a large, observational cohort of women taking antipsychotics drugs compared with anticonvulsants or lithium. A new user design was used that required 12 months of insurance enrollment before the first antipsychotic or anticonvulsant/lithium prescription. Invasive breast cancer was identified using diagnostic codes. Multivariable Cox proportional hazards models were used to evaluate the risk of breast cancer with antipsychotic drug exposure controlling for age and other risk factors. FINDINGS/RESULTS A total of 914 cases (0.16%) of invasive breast cancer were identified among 540,737 women. Exposure to all antipsychotics was independently associated with a 35% increased risk of breast cancer (aHR [adjusted hazard ratio], 1.35; 95% confidence interval, 1.14-1.61). Category 1 drugs (high prolactin) were associated with a 62% increased risk (aHR, 1.62; 95% CI, 1.30-2.03), category 2 drugs a 54% increased risk (aHR, 1.54; 95% CI, 1.19-1.99), and category 3 drugs were not associated with breast cancer risk. IMPLICATIONS/CONCLUSIONS In the largest study of antipsychotics taken by US women, a higher risk between antipsychotic drug use and increased risk for breast cancer was observed, with a differential higher association with antipsychotic categories that elevate prolactin. Our study confirms other recent observational studies of increased breast cancer risk with antipsychotics that elevate prolactin.
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Affiliation(s)
- Tahir Rahman
- From the Washington University School of Medicine
| | | | - Margaret A Olsen
- Divisions of Infectious Diseases and Public Health Sciences, Departments of Medicine and Surgery
| | | | | | - Cynthia Ma
- Department of Medicine/Siteman Cancer Center, Washington University in St Louis, School of Medicine
| | - Richard A Grucza
- Department of Family and Community Medicine and Department of Health Outcomes Research, St Louis University School of Medicine, St Louis, MO
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5
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Dong R, Zhao NO, Wu HE, Yu L, Zhang XY. Sex differences in the association between serum BDNF and cognitive impairment in schizophrenia patients using various antipsychotics. J Psychiatr Res 2021; 138:492-499. [PMID: 33971483 DOI: 10.1016/j.jpsychires.2021.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/25/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment is one of the core symptoms of schizophrenia patients. There are often various differences in the efficacy of different antipsychotics in the treatment of cognitive impairment by sex. The purpose of this study was to explore whether there are gender differences in the association between serum BDNF levels and cognitive performance in patients with schizophrenia taking different antipsychotics. METHODS We used Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to assess the cognitive function of three groups of schizophrenia patients (420 on clozapine, 183 on risperidone, 215 on typical antipsychotic drugs) and 467 healthy controls. Positive and Negative Syndrome Scale (PANSS) was used to assess schizophrenia symptoms of patients. Enzyme-Linked ImmunoSorbent Assay was used to measure serum brain-derived neurotrophic factor (BDNF) levels. RESULTS Among the patients taking clozapine and typical antipsychotic drugs, the RBANS total score, immediate memory, attention, and delayed memory subscores in females were higher than those in males (all p < 0.05). The RBANS total score and the delayed memory subscores in female patients taking risperidone were higher than those in male patients (all p < 0.05). Significant correlation between BDNF and cognition only existed in male patients taking clozapine, male patients taking risperidone, and male and female patients taking typical antipsychotic drugs (all p < 0.05). CONCLUSION Regardless of antipsychotic effect, the cognitive function of female patients is better compared to that of male patients. For male patients, the association between BDNF and cognitive performance exists in each medication group. For female patients, this significant association was only shown in the typical antipsychotic group, but not in the clozapine and risperidone groups.
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Affiliation(s)
- Rui Dong
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
| | - Ning Olivia Zhao
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Liling Yu
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China.
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Ruljancic N, Bakliza A, Vuk Pisk S, Geres N, Matic K, Ivezic E, Grosic V, Filipcic I. Antipsychotics-induced hyperprolactinemia and screening for macroprolactin. Biochem Med (Zagreb) 2020; 31:010707. [PMID: 33380894 PMCID: PMC7745162 DOI: 10.11613/bm.2021.010707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/13/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction High prolactin (PRL) concentrations are found in laboratory test results of patients on majority of antipsychotic drugs. Prevalence rates and degrees of severity of hyperprolactinemia (HPRL) based on PRL concentration may depend on the presence of macroprolactin in the serum. The aim of the study was to investigate the difference between PRL concentrations before and after precipitation of macroprolactin and to examine if there were any changes in the categorization of HPRL between samples prior and after precipitation. Materials and methods Total of 98 female patients (median age 33; range 19-47 years) diagnosed with a psychotic disorder, proscribed antipsychotic drugs, and with HPRL were included. Total PRL concentration and PRL concentration after macroprolactin precipitation with polyethylene glycol (postPEG-PRL) were determined by the chemiluminometric method on the Beckman Coulter Access2 analyser. Results Total PRL concentrations (median 1471; IQC: 1064-2016 mlU/L) and postPEG-PRL concentrations (median 1453; IQC: 979-1955 mlU/L) were significantly correlated using intraclass correlation coefficient for single measurements (mean estimation 0.96; 95%CI 0.93-0.97) and average measurement (mean estimation 0.98; 95%CI 0.96-0.99), and all investigated female patient had HPRL according to PRL and postPEG-PRL concentration. The median PRL recovery following PEG precipitation was 95; IQC: 90-100%. There was substantial agreement (kappa test = 0.859, 95% CI: 0.764-0.953) between the categories of HPRL severity based on total PRL concentrations and postPEG-PRL concentrations. Conclusion The study demonstrated that HPRL was present in all subjects using the reference interval for total PRL concentration and postPEG-PRL concentration with no significant impact of macroprolactin presence in the serum on the categorization of patients according to severity of HPRL.
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Affiliation(s)
- Nedjeljka Ruljancic
- Department of Laboratory Diagnostics, Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia.,Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia
| | - Ana Bakliza
- Department of Laboratory Diagnostics, Psychiatric Hospital "Sveti Ivan" Zagreb, Croatia
| | - Sandra Vuk Pisk
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Natko Geres
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Katarina Matic
- Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Ena Ivezic
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Vladimir Grosic
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia
| | - Igor Filipcic
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia.,Department of Integrative Psychiatry, Psychiatric Hospital 'Sveti Ivan' Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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7
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Zhou YF, Huang JC, Zhang P, Fan FM, Chen S, Fan HZ, Cui YM, Luo XG, Tan SP, Wang ZR, Feng W, Yuan Y, Yang FD, Savransky A, Ryan M, Goldwaser E, Chiappelli J, Rowland LM, Kochunov P, Tan YL, Hong LE. Choroid Plexus Enlargement and Allostatic Load in Schizophrenia. Schizophr Bull 2020; 46:722-731. [PMID: 31603232 PMCID: PMC7147577 DOI: 10.1093/schbul/sbz100] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although schizophrenia is a brain disorder, increasing evidence suggests that there may be body-wide involvement in this illness. However, direct evidence of brain structures involved in the presumed peripheral-central interaction in schizophrenia is still unclear. Seventy-nine previously treatment-naïve first-episode schizophrenia patients who were within 2-week antipsychotics initial stabilization, and 41 age- and sex-matched healthy controls were enrolled in the study. Group differences in subcortical brain regional structures measured by MRI and the subclinical cardiovascular, metabolic, immune, and neuroendocrine biomarkers as indexed by allostatic load, and their associations were explored. Compared with controls, patients with schizophrenia had significantly higher allostatic load (P = .001). Lateral ventricle (P < .001), choroid plexus (P < .001), and thalamus volumes (P < .001) were significantly larger, whereas amygdala volume (P = .001) was significantly smaller in patients. The choroid plexus alone was significantly correlated with higher allostatic load after age, sex, education level, and the total intracranial volume were taken into account (t = 3.60, P < .001). Allostatic load was also significantly correlated with PANSS positive (r = 0.28, P = .016) and negative (r = -0.31, P = .008) symptoms, but in opposite directions. The peripheral multisystemic and central nervous system abnormalities in schizophrenia may interact through the choroid plexus during the early stage of the illness. The choroid plexus might provide a sensitive structural biomarker to study the treatment and prevention of brain-periphery interaction abnormalities in schizophrenia.
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Affiliation(s)
- Yan-Fang Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Jun-Chao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Ping Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Feng-Mei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Hong-Zhen Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Yi-Min Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, P. R. China
| | - Xing-Guang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Shu-Ping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Zhi-Ren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Wei Feng
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Ying Yuan
- School of Foreign Languages and Literature, Tianjin University, Tianjin, P. R. China
| | - Fu-De Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China
| | - Anya Savransky
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Meghann Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Eric Goldwaser
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Laura M Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Yun-Long Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China,To whom correspondence should be addressed; Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P. R. China; tel: +86-(10)-83024319, fax: +86-(10)-62710156, e-mail:
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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8
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Alvarez-Herrera S, Escamilla R, Medina-Contreras O, Saracco R, Flores Y, Hurtado-Alvarado G, Maldonado-García JL, Becerril-Villanueva E, Pérez-Sánchez G, Pavón L. Immunoendocrine Peripheral Effects Induced by Atypical Antipsychotics. Front Endocrinol (Lausanne) 2020; 11:195. [PMID: 32373066 PMCID: PMC7186385 DOI: 10.3389/fendo.2020.00195] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
Atypical antipsychotics (AAP) or second-generation antipsychotics are the clinical option for schizophrenia treatment during acute psychoses, but they are also indicated for maintenance during lifetime, even though they are being used for other psychiatric conditions in clinical practice such as affective disorders and autism spectrum disorder, among others. These drugs are differentiated from typical antipsychotics based on their clinical profile and are a better choice because they cause fewer side effects regarding extrapyramidal symptoms (EPS). Even though they provide clear therapeutic benefits, AAP induce peripheral effects that trigger phenotypic, functional, and systemic changes outside the Central Nervous System (CNS). Metabolic disease is frequently associated with AAP and significantly impacts the patient's quality of life. However, other peripheral changes of clinical relevance are present during AAP treatment, such as alterations in the immune and endocrine systems as well as the intestinal microbiome. These less studied alterations also have a significant impact in the patient's health status. This manuscript aims to revise the peripheral immunological, endocrine, and intestinal microbiome changes induced by AAP consumption recommended in the clinical guidelines for schizophrenia and other psychiatric disorders.
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Affiliation(s)
- Samantha Alvarez-Herrera
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Raúl Escamilla
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Oscar Medina-Contreras
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México, Mexico
| | - Ricardo Saracco
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Yvonne Flores
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Gabriela Hurtado-Alvarado
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autonoma Metropolitana-Iztapalapa, Mexico City, Mexico
| | - José Luis Maldonado-García
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Enrique Becerril-Villanueva
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Gilberto Pérez-Sánchez
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Lenin Pavón
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
- *Correspondence: Lenin Pavón
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9
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Giant cabergoline-resistant prolactinoma in a man who presented with a psychotic episode during treatment: a case report. J Med Case Rep 2019; 13:183. [PMID: 31202268 PMCID: PMC6571118 DOI: 10.1186/s13256-019-2071-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prolactinomas are tumors of the pituitary gland that usually respond very well to treatment with cabergoline. Resistance to cabergoline is very rare, but when it occurs, it is a difficult problem to resolve if the tumor is inoperable. Case presentation A 62-year-old white man was treated for a giant macroprolactinoma detected during investigation of a subacute subdural hematoma of the left frontal lobe. The patient was treated with cabergoline for 17 years with a dose ranging from 1.0 mg to 3.5 mg per week. We were not able to normalize his prolactin level, which initially was 14,992 ng/ml and ultimately 1754 ng/ml. The tumor significantly shrank during the follow-up period but persisted. The patient had cardiac valvulopathies that did not worsen. He had an ischemic stroke and developed a psychotic condition that was successfully treated by lowering the cabergoline and administering quetiapine and mirtazapine together. This regimen led to a small increase in the patient’s prolactin that returned to previous levels and remained as such until the last medical evaluation. The tumor continued to shrink and had a cystic degeneration in the last evaluation. Conclusions Combined use of cabergoline with quetiapine and mirtazapine to treat a psychotic crisis may have contributed to shrinking the tumor in our patient because these antipsychotics have action mediated by growth factors that interfere with growth of pituitary tumors.
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10
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Case Report: Paliperidone Palmitate, But Not Aripiprazole, as a Possible Risk Factor for Pulmonary Embolism. J Clin Psychopharmacol 2018; 38:392-394. [PMID: 29746335 DOI: 10.1097/jcp.0000000000000888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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11
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Sturm S, Delporte ML, Hadi S, Schobel S, Lindemann L, Weikert R, Jaeschke G, Derks M, Palermo G. Results and evaluation of a first-in-human study of RG7342, an mGlu5 positive allosteric modulator, utilizing Bayesian adaptive methods. Br J Clin Pharmacol 2017; 84:445-455. [PMID: 29096426 DOI: 10.1111/bcp.13466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 10/12/2017] [Accepted: 10/21/2017] [Indexed: 12/13/2022] Open
Abstract
AIM The objectives of this first-in-human study were to evaluate the safety and tolerability, pharmacokinetics and pharmacodynamics, and maximum tolerated dose (MTD) of single ascending oral doses of RG7342, a positive allosteric modulator (PAM) of the metabotropic glutamate receptor 5 (mGlu5) for the treatment of schizophrenia, in healthy male subjects. METHODS This was a single-centre, randomized, double-blind, adaptive study of 37 subjects receiving single ascending oral doses of RG7342 (ranging from 0.06-1.2 mg, n = 27) or placebo (n = 10). A modified continual reassessment method, with control for the probability of overdosing based on the occurrence of dose-limiting events (DLEs), was applied to inform the subsequent dose decisions for RG7342. RESULTS DLEs consisted of dizziness, nausea and vomiting, and the incidence and severity of these adverse events increased in a concentration-dependent manner. RG7342 doses of 1.2 mg under fasting conditions, which reached a mean maximum plasma concentration (Cmax ) of 10.2 ng ml-1 , were not tolerated (four out of six subjects experienced DLEs). RG7342 showed dose-proportional pharmacokinetics, with rapid absorption and a biphasic decline, and a mean terminal half-life estimated to be >1000 h. CONCLUSIONS Single oral doses of RG7342 were generally tolerated up to 0.6 mg under fasting and 0.9 mg under fed conditions in healthy subjects. Bayesian adaptive methods describing the probability of DLEs were applied effectively to support dose escalation. MTDs (fasting, fed) were associated with a Cmax of 6.5 ng ml-1 . The development of RG7342 was discontinued owing to the potential challenges associated with a long half-life in context of the observed adverse events.
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Affiliation(s)
- Stefan Sturm
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
| | - Marie-Laure Delporte
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
| | - Salah Hadi
- PRA Health Sciences (PRA) - Early Development Services, Van Swietenlaan 6 Clinical Site, Groningen, the Netherlands
| | - Scott Schobel
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
| | - Lothar Lindemann
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
| | - Robert Weikert
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
| | - Georg Jaeschke
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
| | - Michael Derks
- Roche Innovation Center Welwyn, Roche Pharmaceutical Research and Early Development, 6 Falcon Way, Welwyn Garden City, UK
| | - Giuseppe Palermo
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Grenzacherstrasse 124, Basel, Switzerland
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Grigg J, Worsley R, Thew C, Gurvich C, Thomas N, Kulkarni J. Antipsychotic-induced hyperprolactinemia: synthesis of world-wide guidelines and integrated recommendations for assessment, management and future research. Psychopharmacology (Berl) 2017; 234:3279-3297. [PMID: 28889207 DOI: 10.1007/s00213-017-4730-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/22/2017] [Indexed: 01/25/2023]
Abstract
RATIONALE Hyperprolactinemia is a highly prevalent adverse effect of many antipsychotic agents, with potentially serious health consequences. Several guidelines have been developed for the management of this condition; yet, their concordance has not been evaluated. OBJECTIVES The objectives of this paper were (1) to review current clinical guidelines; (2) to review key systematic evidence for management; and (3) based on our findings, to develop an integrated management recommendation specific to male and female patients who are otherwise clinically stabilised on antipsychotics. METHODS We performed searches of Medline and EMBASE, supplemented with guideline-specific database and general web searches, to identify clinical guidelines containing specific recommendations for antipsychotic-induced hyperprolactinemia, produced/updated 01/01/2010-15/09/2016. A separate systematic search was performed to identify emerging management approaches described in reviews and meta-analyses published ≥ 2010. RESULTS There is some consensus among guidelines relating to baseline PRL screening (8/12 guidelines), screening for differential diagnosis (7/12) and discontinuing/switching PRL-raising agent (7/12). Guidelines otherwise diverge substantially regarding most aspects of screening, monitoring and management (e.g. treatment with dopamine agonists). There is an omission of clear sex-specific recommendations. Systematic literature on management approaches is promising; more research is needed. An integrated management recommendation is presented to guide sex-specific clinical response to antipsychotic-induced hyperprolactinemia. Key aspects include asymptomatic hyperprolactinemia monitoring and fertility considerations with PRL normalisation. CONCLUSION Further empirical work is key to shaping robust guidelines for antipsychotic-induced hyperprolactinemia. The integrated management recommendation can assist clinician and patient decision-making, with the goal of balancing effective psychiatric treatment while minimising PRL-related adverse health effects in male and female patients.
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Affiliation(s)
- Jasmin Grigg
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Roisin Worsley
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Caroline Thew
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Caroline Gurvich
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Natalie Thomas
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia
| | - Jayashri Kulkarni
- The Monash Alfred Psychiatry Research Centre, Monash University, Level 4, 607 St Kilda Rd, Melbourne, 3004, Victoria, Australia.
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13
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Reutfors J, Wingård L, Brandt L, Wang Y, Qiu H, Kieler H, Bahmanyar S. Risk of breast cancer in risperidone users: A nationwide cohort study. Schizophr Res 2017; 182:98-103. [PMID: 27823949 DOI: 10.1016/j.schres.2016.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Several antipsychotics, especially risperidone, are known to increase serum prolactin. Hyperprolactinemia has been linked to the development of mammary gland tumors in animal studies. We therefore investigated the risk of breast cancer in a nationwide cohort of women using risperidone or other antipsychotics. METHODS All women, 18years or older, who initiated treatment with risperidone or any other antipsychotic between 2006 and 2012 were identified in Swedish nationwide registers. Patients with two consecutive dispensations of the same antipsychotic within 3months, no previous cancer diagnosis, and no previous dispensations of paliperidone were included. The final cohort consisted of 55976 women of whom 22908, 24524, and 8544 were exposed to risperidone, other atypical antipsychotics, and typical antipsychotics, respectively. A Cox regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the association between antipsychotics and breast cancer. RESULTS Patients were followed prospectively, the mean follow-up time ranging from 2.4 to 2.8years between treatment groups. After adjusting for age, there was no increased risk for breast cancer among risperidone users compared to patients exposed to another atypical antipsychotic (HR 0.94, 95% CI 0.72-1.22) or a typical antipsychotic (HR 1.25, 95% CI 0.94-1.66). Analyses stratified by tumor stage, using active treatment follow-up time, or including only treatment naïve patients did not reveal any noteworthy change in the results. CONCLUSION Risperidone use does not confer an increased short-term risk of breast cancer compared to other antipsychotic agents.
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Affiliation(s)
- Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Louise Wingård
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yiting Wang
- Janssen Research and Development, Department of Epidemiology, Titusville, NJ, USA
| | - Hong Qiu
- Janssen Research and Development, Department of Epidemiology, Titusville, NJ, USA
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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