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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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Wang Z, Zheng Y, Fan Y, Fan Y, Su X, Wang B, Li J, Chen D, Sun F, Li S, Ma J, Li X, Bai L, Li R. Peony-Glycyrrhiza Decoction for Antipsychotic-Related Hyperprolactinemia in Patients with Schizophrenia: A Randomized Controlled Trial. Neuropsychiatr Dis Treat 2023; 19:929-938. [PMID: 37089913 PMCID: PMC10120814 DOI: 10.2147/ndt.s408314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023] Open
Abstract
Background Most antipsychotic drugs are dopamine receptor antagonists that usually lead to abnormal increases in prolactin concentrations and the development of hyperprolactinemia (HPRL), which in turn causes sexual dysfunction in patients. Peony-Glycyrrhiza Decoction (PGD) enhanced dopamine D2 receptors (DRD2) and dopamine transporter (DAT) and significantly reversed the expression of DRD2 and DAT. Therefore, we hypothesized that PGD might effectively improve hyperprolactinemia and alleviate sexual dysfunction in patients. Methods We performed an 8-week randomized controlled study on 62 subjects with schizophrenia who were randomized into two groups. The experimental group was treated with the PGD intervention, and the control group did not receive treatment. The primary outcome indicators were the levels of sex hormones and the total Arizona Sexual Experience Scale (ASEX) score. Results There was a significant difference in PRL levels between the two groups at weeks 4 and 8. From the beginning to the end of the experiment, there was a significant increase in PRL levels in the control group, while there was no significant change in the experimental group. The ASEX scale assessed sexual function in both groups, and patients in the experimental group showed an improvement in sexual function at week 8. During the experiment, the two groups found no differences between Positive and Negative Syndrome Scale (PANSS) scores and Treatment Emergent Symptom Scale (TESS) scores. Conclusion PGD significantly improved the patient's sexual function but was less effective in reducing prolactin levels and may prevent further increases in prolactin levels.
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Affiliation(s)
- Zhongbao Wang
- Department of Psychiatry, Jining Medical University, Jining, People’s Republic of China
| | - Yunshao Zheng
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Yunli Fan
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Yunming Fan
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Xianbiao Su
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Bingrui Wang
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Jing Li
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Diancai Chen
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Fengxia Sun
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Shen Li
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Jiashu Ma
- Department of Psychiatry, Jining Medical University, Jining, People’s Republic of China
| | - Xianwei Li
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Ludong Bai
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
| | - Ranran Li
- Department of Psychiatry, Shandong Mental Health Center, Shandong University, Jinan, People’s Republic of China
- Correspondence: Ranran Li, Department of Psychiatry, Shandong Mental Health Center, Shandong University, 49 East Wenhua Road, Jinan, Shandong, 250014, People’s Republic of China, Tel +86 18678777190, Email
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Lu Z, Sun Y, Zhang Y, Chen Y, Guo L, Liao Y, Kang Z, Feng X, Yue W. Pharmacological treatment strategies for antipsychotic-induced hyperprolactinemia: a systematic review and network meta-analysis. Transl Psychiatry 2022; 12:267. [PMID: 35790713 PMCID: PMC9256633 DOI: 10.1038/s41398-022-02027-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 12/18/2022] Open
Abstract
Antipsychotic-induced hyperprolactinemia (AP-induced HPRL) occurs overall in up to 70% of patients with schizophrenia, which is associated with hypogonadism and sexual dysfunction. We summarized the latest evidence for the benefits of prolactin-lowering drugs. We performed network meta-analyses to summarize the evidence and applied Grading of Recommendations Assessment, Development, and Evaluation frameworks (GRADE) to rate the certainty of evidence, categorize interventions, and present the findings. The search identified 3,022 citations, 31 studies of which with 1999 participants were included in network meta-analysis. All options were not significantly better than placebo among patients with prolactin (PRL) less than 50 ng/ml. However, adjunctive aripiprazole (ARI) (5 mg: MD = -64.26, 95% CI = -87.00 to -41.37; 10 mg: MD = -59.81, 95% CI = -90.10 to -29.76; more than 10 mg: MD = -68.01, 95% CI = -97.12 to -39.72), switching to ARI in titration (MD = -74.80, 95% CI = -134.22 to -15.99) and adjunctive vitamin B6 (MD = -91.84, 95% CI = -165.31 to -17.74) were associated with significant decrease in AP-induced PRL among patients with PRL more than 50 ng/ml with moderated (adjunctive vitamin B6) to high (adjunctive ARI) certainty of evidence. Pharmacological treatment strategies for AP-induced HPRL depends on initial PRL level. No effective strategy was found for patients with AP-induced HPRL less than 50 ng/ml, while adjunctive ARI, switching to ARI in titration and adjunctive high-dose vitamin B6 showed better PRL decrease effect on AP-induced HPRL more than 50 ng/ml.
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Affiliation(s)
- Zhe Lu
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Yaoyao Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Yuyanan Zhang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Yu Chen
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Liangkun Guo
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Yundan Liao
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Zhewei Kang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Xiaoyang Feng
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China
| | - Weihua Yue
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China.
- National Clinical Research Center for Mental Disorders, (Peking University Sixth Hospital), Beijing, 100191, China.
- NHC Key Laboratory of Mental Health, Peking University, Beijing, 100191, China.
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China.
- Chinese Institute for Brain Research, Beijing, 102206, China.
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Rusgis MM, Alabbasi AY, Nelson LA. Guidance on the treatment of antipsychotic-induced hyperprolactinemia when switching the antipsychotic is not an option. Am J Health Syst Pharm 2021; 78:862-871. [PMID: 33954421 PMCID: PMC7989660 DOI: 10.1093/ajhp/zxab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This article aims to evaluate management options for antipsychotic-induced hyperprolactinemia and associated treatment considerations such as efficacy, tolerability, drug interactions, contraindications, and dosing regimens. Summary Hyperprolactinemia is a common adverse effect of antipsychotics. First-line management includes reducing the dose of the offending antipsychotic, discontinuing the antipsychotic, or switching to another antipsychotic associated with a lower risk of hyperprolactinemia. However, these options are not always practical and are associated with a risk of relapse of the psychiatric illness. Other management options include adjunctive aripiprazole, dopamine agonists (cabergoline and bromocriptine), metformin, and herbal supplements. A search of Embase, PubMed, and Google Scholar using key terms such as hyperprolactinemia, prolactin, antipsychotic, treatment guidelines, aripiprazole, dopamine agonist, cabergoline, bromocriptine, metformin, herbals, supplements, and medications was conducted for literature retrieval. Upon evaluation of the available literature we found the following: (1) aripiprazole is safe and effective in lowering prolactin levels within normal limits; (2) adjunctive cabergoline and bromocriptine decrease elevated prolactin levels, while cabergoline may be more effective in reducing prolactin but can also be associated with a more serious adverse effect of cardiac valvular abnormalities; (3) metformin causes a mild reduction of prolactin levels; and (4) there are limited data to support use of herbal medications (chamomile, Peony-Glycyrrhiza decoction, and shakuyaku-kanzo-to) in antipsychotic-induced hyperprolactinemia Conclusion There are treatments available for antipsychotic-induced hyperprolactinemia in patients who are unable to alter their current antipsychotic regimen. However, there remains a need for additional short- and long-term studies to determine the efficacy and safety of these treatment strategies, given that patients taking antipsychotics typically require chronic, life-long treatment for their illnesses.
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Affiliation(s)
- Matthew M Rusgis
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Afaq Y Alabbasi
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Leigh Anne Nelson
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
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Zhang L, Qi H, Xie YY, Zheng W, Liu XH, Cai DB, Ng CH, Ungvari GS, Xiang YT. Efficacy and Safety of Adjunctive Aripiprazole, Metformin, and Paeoniae-Glycyrrhiza Decoction for Antipsychotic-Induced Hyperprolactinemia: A Network Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:728204. [PMID: 34658963 PMCID: PMC8511431 DOI: 10.3389/fpsyt.2021.728204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022] Open
Abstract
Aripiprazole, metformin, and paeoniae-glycyrrhiza decoction (PGD) have been widely used as adjunctive treatments to reduce antipsychotic (AP)-induced hyperprolactinemia in patients with schizophrenia. However, the comparative efficacy and safety of these medications have not been previously studied. A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety between aripiprazole, metformin, and PGD as adjunctive medications in reducing AP-induced hyperprolactinemia in schizophrenia. Both international (PubMed, PsycINFO, EMBASE, and Cochrane Library databases) and Chinese (WanFang, Chinese Biomedical, and Chinese National Knowledge infrastructure) databases were searched from their inception until January 3, 2019. Data were analyzed using the Bayesian Markov Chain Monte Carlo simulations with the WinBUGS software. A total of 62 RCTs with 5,550 participants were included in the meta-analysis. Of the nine groups of treatments included, adjunctive aripiprazole (<5 mg/day) was associated with the most significant reduction in prolactin levels compared to placebo (posterior MD = -65.52, 95% CI = -104.91, -24.08) and the other eight treatment groups. Moreover, adjunctive PGD (>1:1) was associated with the lowest rate of all-cause discontinuation compared to placebo (posterior odds ratio = 0.45, 95% CI = 0.10, 3.13) and adjunctive aripiprazole (>10 mg/day) was associated with fewer total adverse drug events than placebo (posterior OR = 0.93, 95% CI = 0.65, 1.77) and other eight treatment groups. In addition, when risperidone, amisulpride, and olanzapine were the primary AP medications, adjunctive paeoniae/glycyrrhiza = 1:1, aripiprazole <5 mg/day, and aripiprazole >10 mg/day were the most effective treatments in reducing the prolactin levels, respectively. Adjunctive aripiprazole, metformin, and PGD showed beneficial effects in reducing AP-induced hyperprolactinemia in schizophrenia, with aripiprazole (<5 mg/day) being the most effective one.
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Affiliation(s)
- Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Han Qi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, The Advanced Innovation Center for Human Brain Protection, School of Mental Health, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yun-Yi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiao-Hui Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia.,Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR China
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6
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Huang X, Ren L, Hou L, Fan H, Wang C, Wang C, Li Y. Paeoniflorin ameliorates antipsychotic-induced hyperprolactinemia in rats by attenuating impairment of the dopamine D2 receptor and TGF-β1 signaling pathways in the hypothalamus and pituitary. JOURNAL OF ETHNOPHARMACOLOGY 2020; 257:112862. [PMID: 32294507 DOI: 10.1016/j.jep.2020.112862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/07/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Paeoniflorin, a prominent component in some Chinese formulas for hyperprolactinemia-associated disorders, has been found to inhibit prolactin secretion in prolactinoma cells. AIM To examine the efficacy of paeoniflorin on hyperprolactinemia and the underlying mechanisms of action. MATERIALS AND METHODS Hyperprolactinemia in female rats was generated by administration of olanzapine (5 mg/kg, by a gavage method, once daily, × 13 weeks). The rats were co-treated with paeoniflorin (10 and 50 mg/kg). Prolactin and TGF-β1 concentrations were detected by ELISA. Protein expression was determined by Western blot. The effect in MMQ cells was also examined. RESULTS Paeoniflorin inhibited olanzapine-induced increases in plasma prolactin concentration and prolactin protein overexpression in the pituitary and hypothalamus of rats. Further, paeoniflorin restored olanzapine-induced downregulation of pituitary and hypothalamic dopamine D2 receptor (D2R) protein expression. More importantly, paeoniflorin attenuated olanzapine-suppressed protein expression of transforming growth factor (TGF)-β1 and its downstream genes, type II TGF-β receptor, type I TGF-β receptor and phosphorylated SMAD3 in the tissues. However, paeoniflorin did not affect plasma TGF-β1 concentration and hepatic TGF-β1 protein expression. In accord, olanzapine-induced increase in prolactin concentration, upregulation of prolactin protein expression, and downregulation of protein expression of the D2R and TGF-β1 signals in MMQ cells were attenuated. CONCLUSIONS This study demonstrates that paeoniflorin ameliorates olanzapine-induced hyperprolactinemia in rats by attenuating impairment of the D2R and TGF-β1 signaling pathways in the hypothalamus and pituitary. Our findings may provide evidence to support the use of paeoniflorin-contained Chinese herbs and formulas for hyperprolactinemia and its associated disorders.
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Affiliation(s)
- Xiaoqian Huang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Liying Ren
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Lianbing Hou
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Hua Fan
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Chengliang Wang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Chunxia Wang
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China; Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Yuhao Li
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China; Endocrinology and Metabolism Group, Sydney Institute of Health Sciences/Sydney Institute of Traditional Chinese Medicine, NSW, 2000 Australia.
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Zhou XD, Yang XJ, Zheng Y, Qin ZS, Sha W, Chen G, Zhang ZJ. Jie-Yu Pill, A Proprietary Herbal Medicine, Ameliorates Mood Disorder-Like Behavior and Cognitive Impairment in Estrogen-Deprived Mice Exposed to Chronic Unpredictable Mild Stress: Implication for a Potential Therapy of Menopause Syndrome. Front Psychiatry 2020; 11:579995. [PMID: 33329121 PMCID: PMC7673394 DOI: 10.3389/fpsyt.2020.579995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Jie-Yu Pill (JYP) is a proprietary herbal medicine initially developed to treat menstrual mood disorders. This study sought to determine whether JYP could alleviate menopausal psychiatric symptoms in ovariectomized (OVX) mice, an animal model of estrogen deprivation, exposed to chronic unpredictable mild stress (CUMS) and the underlying mechanisms in comparison with estrogen therapy. The OVX+CUMS mice were treated with 0.3 mg/kg estradiol (E2), 2.5 g/kg or 5 g/kg JYP for 36 days, and tested in multiple behavioral paradigms. Serum, uterus, and brain tissues were collected for the measurement of hypothalamus-pituitary-ovarian axis (HPO) and hypothalamus-pituitary-adrenal (HPA) axis hormones, γ-aminobutyric acid (GABA), glutamate, neurotrophins, and estrogen receptors. JYP and E2 had comparable efficacy in reducing anxiety- and depression-like behavior and cognitive impairment of the OVX+CUMS mice. E2 strikingly increased ratio of uterus to body weight of the OVX+CUMS mice, but JYP did not. Both agents suppressed HPO-axis upstream hormones, inhibited HPA-axis hyperactivity by reinstating hypothalamic GABA, restored hippocampal and prefrontal glutamate contents and its receptor expression in the OVX+CUMS mice. While JYP and E2 protected against decreases in hippocampal and prefrontal neurotrophins and estrogen receptors of the OVX+CUMS mice, unlike E2, JYP had no significant effects on these biomarkers in the uterus. These results suggest that JYP has comparable efficacy in ameliorating mood disorder-like behavior and cognitive impairment induced by a combination of estrogen deprivation and chronic stress in association with certain differential uterus-brain mechanisms compared to estrogen therapy. JYP may be a potential therapy for menopause-associated psychiatric disorders.
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Affiliation(s)
- Xi-Dan Zhou
- Li Ka Shing (LKS) Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Xin-Jing Yang
- Li Ka Shing (LKS) Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Yu Zheng
- Li Ka Shing (LKS) Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Zong-Shi Qin
- Li Ka Shing (LKS) Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China
| | - Wei Sha
- Department of Research and Development, Henan Taifeng Biological Technology Corporation Limited, Kaifeng, China
| | - Gang Chen
- Interdisciplinary Institute for Personalized Medicine in Brain Disorders, Jinan University, Guangzhou, China
| | - Zhang-Jin Zhang
- Li Ka Shing (LKS) Faculty of Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong, China.,Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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8
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Zheng W, Cai DB, Yang XH, Ungvari GS, Ng CH, Shi ZM, Hu ML, Ning YP, Xiang YT. Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia: a meta-analysis. Gen Psychiatr 2019; 32:e100091. [PMID: 31673677 PMCID: PMC6802974 DOI: 10.1136/gpsych-2019-100091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/15/2019] [Accepted: 08/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Hyperprolactinaemia is a common antipsychotic (AP)-induced adverse effect, particularly in female patients. Aims This meta-analysis examined the efficacy and safety of adjunctive aripiprazole in preventing AP-related hyperprolactinaemia in patients with first-episode schizophrenia. Methods PubMed, PsycINFO, EMBASE, Cochrane Library, WanFang and China Journal Net databases were searched to identify eligible randomised controlled trials (RCTs). Primary outcomes were the reductions of serum prolactin level and prolactin-related symptoms. Data were independently extracted by two reviewers and analysed using RevMan (V.5.3). Weighted/standardised mean differences (WMDs/SMDs)±95% CIs were reported. Results In the five RCTs (n=400), the adjunctive aripiprazole (n=197) and the control groups (n=203) with a mean of 11.2 weeks of treatment duration were compared. The aripiprazole group had a significantly lower endpoint serum prolactin level in all patients (five RCTs, n=385; WMD: −50.43 ng/mL (95% CI: −75.05 to −25.81), p<0.00001; I2=99%), female patients (two RCTs, n=186; WMD: −22.58 ng/mL (95% CI: −25.67 to −19.49), p<0.00001; I2=0%) and male patients (two RCTs, n=127; WMD: −68.80 ng/mL (95% CI: −100.11 to −37.49), p<0.0001). In the sensitivity analysis for the endpoint serum prolactin level in all patients, the findings remained significant (p<0.00001; I2=96%). The aripiprazole group was superior to the control group in improving negative symptoms as assessed by the Positive and Negative Syndrome Scale (three RCTs, n=213; SMD: −0.51 (95% CI: −0.79 to −0.24), p=0.0002; I2=0%). Adverse effects and discontinuation rates were similar between the two groups. Conclusions Adjunctive aripiprazole appears to be associated with reduced AP-induced hyperprolactinaemia and improved prolactin-related symptoms in first-episode schizophrenia. Further studies with large sample sizes are needed to confirm these findings.
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Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China.,School of Medicine, Xiamen University, Xiamen, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine, Shenzhen, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Zhan-Ming Shi
- Chongqing Jiangbei Mental Health Center, Chongqing, China
| | - Mei-Ling Hu
- Shangrao Fifth People's Hospital, Shangrao, China
| | - Yu-Ping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
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Zheng W, Cai DB, Li HY, Wu YJ, Ng CH, Ungvari GS, Xie SS, Shi ZM, Zhu XM, Ning YP, Xiang YT. Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia: a meta-analysis of randomised controlled trials. Gen Psychiatr 2018; 31:e100003. [PMID: 30582119 PMCID: PMC6211273 DOI: 10.1136/gpsych-2018-100003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hyperprolactinaemia is a common adverse effect of antipsychotics (APs). The results of Peony-Glycyrrhiza decoction (PGD) as a potentially useful adjunctive treatment for hyperprolactinaemia are inconsistent. AIM This meta-analysis of randomised controlled trials (RCTs) examined the efficacy and safety of adjunctive PGD therapy for AP-induced hyperprolactinaemia. METHODS English (PubMed, Embase, Cochrane Library, PsycINFO) and Chinese (Chinese National Knowledge Infrastructure, Wanfang Data) databases were systematically searched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants: adult patients with schizophrenia; Intervention: PGD plus APs; Comparison: APs plus placebo or AP monotherapy; Outcomes: efficacy and safety; Study design: RCTs. The weighted mean difference (WMD) and risk ratio (RR) along with their 95% CIs were calculated using Review Manager (RevMan) V.5.3 software. RESULTS Five RCTs (n=450) were included and analysed. Two RCTs (n=140) were double-blind and four RCTs (n=409) reported 'random' assignment with specific description. The PGD group showed a significantly lower serum prolactin level at endpoint than the control group (n=380, WMD: -32.69 ng/mL (95% CI -41.66 to 23.72), p<0.00001, I 2 =97%). Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale (n=403, WMD: -0.62 (95% CI -2.38 to 1.15), p=0.49, I 2 =0%). There were similar rates of all-cause discontinuation (n=330, RR 0.93 (95% CI 0.63 to 1.37), p=0.71, I 2 =0%) and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from 'very low' (14.3%), 'low' (42.8%), 'moderate' (14.3%), to 'high' (28.6%). CONCLUSIONS Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without significant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confirm these findings. TRIAL REGISTRATION NUMBER 42016037017.
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Affiliation(s)
- Wei Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Dong-Bin Cai
- Department of Neurology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Hai-Yan Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yu-Jie Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia
- Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Shan-Shan Xie
- Department of Psychiatry, Mental Health Center of Hebei Province, Baoding, China
| | - Zhan-Ming Shi
- Department of Psychiatry, Chongqing Jiangbei Mental Health Hospital, Chongqing, China
| | - Xiao-Min Zhu
- Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yu-Ping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macau, China
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10
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Wei YY, Lin WF, Zhang TH, Tang YX, Wang JJ, Zhong MF. Effectiveness of Traditional Chinese Medicineas as an Adjunct Therapy for Refractory Schizophrenia: A Systematic Review and Meta Analysis. Sci Rep 2018; 8:6230. [PMID: 29670200 PMCID: PMC5906629 DOI: 10.1038/s41598-018-24547-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/04/2018] [Indexed: 11/08/2022] Open
Abstract
Although recent studies focused on traditional Chinese medicine (TCM) for the treatment of refractory schizophrenia have reported that it may be beneficial, there is still lack of convincing evidence and critical meta-analytic work regarding its effectiveness as an adjunctive therapy. Therefore, we performed a meta-analysis to investigate the effectiveness of TCM in combination with antipsychotics for refractory schizophrenia. Fourteen articles involving 1725 patients published as of December 2016 were included which compared antipsychotic therapies to either TCM alone, or TCM as an adjunctive therapy. TCM was observed to have beneficial effects on aspects of the Positive and Negative Syndrome Scale (PANSS) including total score changes and negative score changes, as well as clinical effects estimated with PANSS or the Brief Psychiatric Rating Scale (BPRS). The changes in extrapyramidal side effects (RSESE) scores from baseline to the end of the treatment period were similar in two groups of related trials. TCM was also reported to mitigate some anti-psychotic related side-effects and overall, TCM adjuvant therapy was generally safe and well tolerated. While, the results indicated the potential utility of TCM as an alternative adjunctive therapeutic for refractory schizophrenia treatment, there remains a need for further high-quality studies.
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Affiliation(s)
- Yan-Yan Wei
- Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Wan-Fu Lin
- Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Tian-Hong Zhang
- Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China
| | - Yun-Xiang Tang
- Department of medical psychology, Faculty of Mental Health, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Ji-Jun Wang
- Department of EEG Source Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P. R. China.
| | - Mao-Feng Zhong
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, P.R. China.
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Effect of Peony-Glycyrrhiza Decoction on Amisulpride-Induced Hyperprolactinemia in Women with Schizophrenia: A Preliminary Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:7901670. [PMID: 29317896 PMCID: PMC5727636 DOI: 10.1155/2017/7901670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/12/2017] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study is to observe the effect of Peony-Glycyrrhiza Decoction (PGD) on hyperprolactinemia in women with schizophrenia induced by Amisulpride. Material and Methods A total of 41 female schizophrenia patients receiving Amisulpride were randomly divided into placebo (n = 20) and PGD groups (n = 21). Maintaining the original Amisulpride dose, the two groups were given placebo and PGD, respectively. The levels of Prolactin (PRL) and other hormones were measured on the initial day and at weeks 4 and 8 after treatment. Changes of clinical symptoms in patients with hyperprolactinemia were observed. The PANSS scores were recorded to assess the psychotic symptoms. Results Compared with placebo group, level of PRL decreased while Progesterone increased remarkably in the PGD group at weeks 4 and 8 (p < 0.01), and level of Estradiol in the PGD group increased significantly at week 8 (p < 0.05). There were no differences in PANSS scores and biochemical indexes between two groups at weeks 4 and 8. Conclusion PGD can improve symptoms of hyperprolactinemia and hormone levels in women with schizophrenia caused by Amisulpride, without affecting their mental symptoms and biochemical indexes.
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Zheng W, Yang XH, Cai DB, Ungvari GS, Ng CH, Wang N, Ning YP, Xiang YT. Adjunctive metformin for antipsychotic-related hyperprolactinemia: A meta-analysis of randomized controlled trials. J Psychopharmacol 2017; 31:625-631. [PMID: 28372526 DOI: 10.1177/0269881117699630] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hyperprolactinemia is a common and severe antipsychotic-induced adverse drug reaction. This meta-analysis of randomized controlled trials systematically examined the efficacy and safety of adjunctive metformin for antipsychotic-related hyperprolactinemia in schizophrenia patients. Two independent investigators searched, extracted, and synthesized data. Weighted mean differences and risk ratios with their 95% confidence intervals were calculated using random effect model. Four randomized controlled trials ( n=509) comparing adjunctive metformin ( n=253) with the control groups ( n=256), lasting 22.7 weeks of treatment, were included in the meta-analysis. The metformin group had significantly lower serum prolactin level at endpoint (four randomized controlled trials, n=501; weighted mean difference: -6.87 ug/L (95% confidence interval: -13.24 to -0.51), p=0.03; I2=80%) with "moderate quality" based on the grading of recommendations assessment, development, and evaluation system. In patients with menstrual disturbances, the rate of menstruation resumption was 66.7% in the metformin group and 4.8% in the control group. Adverse drug reactions and all-cause discontinuation (three randomized controlled trials, n=339, risk ratio: 0.76 (95% confidence interval: 0.29, 1.97), p=0.57; I2= 0%) were similar between the two groups. Adjunctive metformin appears to be effective and safe for reducing antipsychotic-induced hyperprolactinemia and prolactin-related symptoms in schizophrenia patients. Higher quality randomized controlled trials with a large sample size are warranted to confirm these findings.
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Affiliation(s)
- Wei Zheng
- 1 Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Xin-Hu Yang
- 1 Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Dong-Bin Cai
- 2 Clinics of Chinese Medicine, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gabor S Ungvari
- 3 The University of Notre Dame Australia/Marian Centre, Perth, Australia.,4 School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- 5 Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nan Wang
- 6 Department of General Psychiatry, Institute of Mental Health, Singapore
| | - Yu-Ping Ning
- 1 Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Yu-Tao Xiang
- 7 Unit of Psychiatry, University of Macau, Macau SAR, China
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