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Shettima FB, Wakil MA, Sheikh TL, Abdulaziz M, Wakawa IA, Beida O. Antipsychotics-related hyperprolactinaemia among patients with schizophrenia in Maiduguri. S Afr J Psychiatr 2024; 30:2133. [PMID: 38444408 PMCID: PMC10912972 DOI: 10.4102/sajpsychiatry.v30i0.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/10/2023] [Indexed: 03/07/2024] Open
Abstract
Background Hyperprolactinaemia among patients on antipsychotic medications is generally overlooked due to lack of outwardly visible symptoms, patient resistance to reporting because the symptoms are perceived as shameful, or to clinician's insufficient knowledge. Aim The study aimed to evaluate the patterns and correlates of hyperprolactinemia among patients with schizophrenia on antipsychotic medications. Setting The study was conducted in a psychiatric facility in Maiduguri, Northeastern Nigeria. Methods A total of 209 patients with schizophrenia were evaluated through a cross-sectional design and assayed for serum prolactin with ELISA Kits. Frequencies and percentages were tabulated for categorical variables. Variables with significant associations with hyperprolactinaemia on chi-square (p < 0.05) were subjected to logistic regression analysis. Results The prevalence of hyperprolactinaemia was 45.9% in all patients on antipsychotic medication. The prevalence because of the use of typical and atypical antipsychotics was 51.5% and 25.0%, respectively. Hyperprolactinaemia was significantly associated with typical antipsychotics (β = 0314, p = 0.002), high overall drug dosage (β = 2.340, p = 0.003), high-dose typical antipsychotics (β = 3.228, p = 0.000), twice daily dosing frequency (β = 2.751, p = 0.001) and polypharmacy (β = 1.828, p = 0.0024). Conclusion The findings support that patients on typical, high-dose antipsychotic medications and polypharmacy have a high prevalence of hyperprolactinaemia. As hyperprolactinaemia is often undetectable, screening and patient psycho-education on the significance of the signs and symptoms of hyperprolactinaemia is required for necessary clinical intervention. Contribution The study provides evidence for the rational use of antipsychotic medications in sub-Saharan Africa.
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Affiliation(s)
- Falmata B Shettima
- Department of Mental Health, Faculty of Psychiatry, Federal Neuropsychiatric Hospital, Maiduguri, Nigeria
| | - Musa A Wakil
- Department of Mental Health, Faculty of Psychiatry, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Taiwo L Sheikh
- Department of Mental Health, Faculty of Psychiatry, Ahmadu Bello University Zaria, Kaduna, Nigeria
| | - Mohammed Abdulaziz
- Department of Mental Health, Faculty of Psychiatry, Federal Neuropsychiatric Hospital Kaduna, Kaduna, Nigeria
| | - Ibrahim A Wakawa
- Department of Mental Health, Faculty of Psychiatry, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Omeiza Beida
- Department of Mental Health, Faculty of Psychiatry, Federal Neuropsychiatric Hospital Kaduna, Kaduna, Nigeria
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Castle D, Li A. Physical health monitoring for people with schizophrenia. Aust Prescr 2023; 46:75-79. [PMID: 38152317 PMCID: PMC10751083 DOI: 10.18773/austprescr.2023.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Schizophrenia is a severe psychiatric disorder associated with significant comorbidities and early mortality. People with schizophrenia have a greater predisposition to the top 6 modifiable global mortality (cardiometabolic) risk factors as defined by the World Health Organization (compared with the general population). These are driven by genetic, lifestyle and disease factors, and obesogenic antipsychotic medications. Smoking, obesity and type 2 diabetes are the most important modifiable cardiometabolic risk factors for cardiovascular disease in people with schizophrenia. Enhanced physical health screening, especially for cardiometabolic risk factors, is recommended for people with schizophrenia. A multidisciplinary holistic approach is recommended for treating people with schizophrenia, using contact with primary care practitioners to review their physical health.
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Affiliation(s)
| | - Amy Li
- Monash University, Clayton, Victoria
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Kim S, Jeong JH, Um YH, Kim TW, Seo HJ, Hong SC. Prolactin Level Changes according to Atypical Antipsychotics Use: A Study Based on Clinical Data Warehouse. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:769-777. [PMID: 37859450 PMCID: PMC10591174 DOI: 10.9758/cpn.23.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 10/21/2023]
Abstract
Objective : Antipsychotic drugs are known as the major cause of non-neoplastic hyperprolactinemia. This study aimed to investigate the levels of serum prolactin depending on the use of antipsychotic drugs in patients through the Clinical Data Warehouse (CDW). Methods : We conducted a cohort search in the CDW application and got 260 patients' medical records diagnosed with schizophrenia, schizotypal and delusional disorders, manic episodes, and bipolar affective disorders who were taking one of risperidone, blonanserin, amisulpride, and olanzapine. After that, we reviewed the medical data and used the ANCOVA analysis and the post hoc test to compare serum prolactin levels among four antipsychotic drug groups. Results : Among the 117 subjects included in the analysis, the mean serum prolactin level was 64.6 ± 54.6 ng/ml. Serum prolactin levels were significantly higher in subjects taking risperidone or amisulpride compared to blonanserin and olanzapine. The female subjects who took blonanserin, olanzapine, and risperidone had significantly higher prolactin levels, but there was no difference in serum prolactin levels between sex in the subjects who took amisulpride. Conclusion : This study suggests the need for regular monitoring of serum prolactin levels in patients who are taking antipsychotics, especially in female patients. And we showed that there is a possibility to conduct more effective and simpler big data research using the CDW. Further studies on the subjects with controlled confounding variables and larger sample groups are needed.
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Affiliation(s)
- Suhyung Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yoo Hyun Um
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Tae-Won Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ho-jun Seo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Shettima FB, Wakil MA, Sheikh TL, Rabbebe IB, Abdulaziz M, Jidda S, Dahiru AMC. Comparative Study of Extrapyramidal Side Effects, Sexual Dysfunctions and Hyperprolactinaemia Using Typical and Atypical Antipsychotic Medications Among Patients with Schizophrenia in Maiduguri. Niger Med J 2023; 64:612-626. [PMID: 38962106 PMCID: PMC11218855 DOI: 10.60787/nmj-64-5-311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background Extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia are major side effects with the use of antipsychotic medications that impede treatment adherence leading to relapse, increased cost of care and rehospitalization among patients with schizophrenia on antipsychotic medications. The study aims to compare the prevalence of extra-pyramidal side effects (EPSE), sexual dysfunctions (SD) and hyperprolactinaemia (HPRL) among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine if any associations exist between extra-pyramidal side effects, sexual dysfunctions and hyperprolactinaemia. Methodology A cross-sectional hospital-based survey involving 209 patients with schizophrenia were interviewed with structured instruments for the assessment of sexual dysfunction, EPSE and the estimation of serum prolactin was done using Enzyme-linked Immunosorbent Assay. Frequencies and Chi-square analysis were used to compare differences in EPSE, SD & HPRL. Results The study revealed non-statistically significant differences as a group between typical and atypical antipsychotic medication in terms of extra-pyramidal side effects, sexual dysfunction and hyperprolactinaemia. However, a significant association was observed when individual drugs were compared with haloperidol causing the highest frequency of hyperprolactinaemia (χ 2 = 14.9, P = 0.011). A significant relationship between sexual dysfunction and hyperprolactinaemia, sexual dysfunction and extra-pyramidal side effects as well as extra-pyramidal and hyperprolactinaemia was found when individual items for sexual functionin were used. Conclusion The significant relationships between sexual dysfunction only in the domains of sexual desire and arousal with hyperprolactinaemia and extrapyramidal side effects as well as hyperprolactinaemia with extrapyramidal side effects point to a common anti-dopaminergic activity of antipsychotics via different pathways. Prospective studies among a larger sample of patients with schizophrenia are needed to unfold these relationships.
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Affiliation(s)
| | - Musa Abba Wakil
- Department of Mental Health, University of Maiduguri Teaching Hospital. Nigeria
| | - Taiwo Lateef Sheikh
- Department of Clinical Services, Federal Neuropsychiatric Hospital Kaduna, Nigeria
| | - Isa Bukar Rabbebe
- Departmental of Mental Health, Federal Neuropsychiatric Hospital Maiduguri, Nigeria
| | - Mohammed Abdulaziz
- Department of Clinical Services, Federal Neuropsychiatric Hospital Kaduna, Nigeria
| | - Said Jidda
- Department of Mental Health, University of Maiduguri Teaching Hospital. Nigeria
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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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25-Hydroxyvitamin D and metabolic-related laboratory values in women with schizophrenia and hyperprolactinemia. J Psychiatr Res 2022; 151:25-29. [PMID: 35429802 DOI: 10.1016/j.jpsychires.2022.03.046] [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: 06/18/2021] [Revised: 02/10/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
Schizophrenia is a severe mental disorder with various medical comorbidities and early mortality. Hyperprolactinemia is common in women and its impact on sexual function, galactorrhea and amenorrhea is well known. This paper evaluates the risk of 25-hydroxy vitamin D deficiency and other metabolic related laboratory abnormalities in women with schizophrenia having hyperprolactinemia (N = 43). The mean prolactin level in these women was 88.5 ± 56.0 ng/mL. We found that 100% of women were overweight of which 74% (32/43) of the women were obese, 56% (23/41) had abnormal total cholesterol levels and 30% (13/43) had high fasting blood glucose. Vitamin D levels were considered deficient or inadequate in 37% of women. We did not see significant correlations of prolactin with laboratory measures, however all female patients had elevated and high prolactin levels, leading to low variability in a small sample, which may have precluded seeing any direct relationships. Recognizing prolactin related side effects and understanding the role of other health measures seen in women with antipsychotic induced hyperprolactinemia in our female patients are critical steps toward better personalization of their care and recovery.
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7
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Tian C, Wang H, Liu Z, Han X, Ning P. Characteristics and Management of Granulomatous Lobular Mastitis Associated with Antipsychotics-Induced Hyperprolactinemia. Breastfeed Med 2022; 17:599-604. [PMID: 35447036 DOI: 10.1089/bfm.2021.0341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Granulomatous lobular mastitis (GM) is a rare inflammatory breast disease. Reports focusing on GM caused by antipsychotic-induced hyperprolactinemia (HPRL) are very rare. Aim: To report a study of GM associated with antipsychotic-induced HPRL and discuss the mechanism and management. Materials and Methods: A retrospective review of patients with GM and psychiatric disorders were carried out. The clinical characteristics, management and outcome were collected and analyzed. The relationship between antipsychotics and GM was evaluated using the Naranjo Adverse Drug Reaction Probability Scale (Naranjo scale). Results: Nineteen female GM patients with psychiatric diseases, aged 21-39 years, who had received antipsychotics for 0.5-10.2 years were included. Most patients took multiple antipsychotics, and 10 (52.6%) took risperidone-containing regimens. Increased prolactin (PRL) was detected in all patients (range 35.15-200 ng/mL). The scores of Naranjo scale were 7-8, indicated the antipsychotics probably induced GM. All patients received systemic therapy, and were prescribed bromocriptine. Seven patients (36.8%) decreased the dose of antipsychotics, six (31.6%) switched antipsychotics, three (15.8%) continued the primary antipsychotics, and three (15.8%) discontinued antipsychotics. In addition, 14 patients (73.7%) received corticosteroid, 4 (21.1%) received antimycobacterials. PRL decreased to normal in 1 month. Seven patients (36.8%) received excisional surgery. After 12 months' follow-up (range 9-56 months), only three patients (15.8%) had a recurrence. Conclusion: Long-term use of antipsychotics may increase PRL levels, and lead to GM. It is vital to assess PRL level and reduce PRL to normal in patients with GM.
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Affiliation(s)
- Chunxiang Tian
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Han Wang
- Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zeyu Liu
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaorong Han
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ping Ning
- Department of Breast Surgery and Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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8
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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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Culpepper L, Vieta E, Kelly DL, Patel MD, Szatmári B, Hankinson A, Earley WR. Minimal Effects of Cariprazine on Prolactin Levels in Bipolar Disorder and Schizophrenia. Neuropsychiatr Dis Treat 2022; 18:995-1011. [PMID: 35591886 PMCID: PMC9112044 DOI: 10.2147/ndt.s348143] [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: 11/13/2021] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many medications used to treat schizophrenia and bipolar I disorder are linked to hyperprolactinemia. The effects of cariprazine, a dopamine D3/D2 receptor partial agonist, on prolactin levels in patients with schizophrenia or bipolar I disorder were evaluated. METHODS Effects on prolactin were evaluated using pooled data from randomized, double-blind, placebo-controlled studies in patients with schizophrenia (4 studies; 6-week duration; cariprazine 1.5-3 mg/d, 4.5-6 mg/d, and 9-12 mg/d), bipolar mania (3 studies; 3-week duration; cariprazine 3-6 and 9-12 mg/d), and bipolar depression (3 studies; 6- to 8-week duration; cariprazine 1.5 and 3 mg/d). Long-term effects were analyzed using open-label studies in patients with schizophrenia (2 studies; 48-week duration) and patients with bipolar mania (1 study; 16-week duration). Change in prolactin levels (ng/mL) from baseline to study endpoint was evaluated in subsets of sex and prior medication use. RESULTS In patients with schizophrenia (male, n = 1377; female, n = 558), median prolactin changes were -1.2 for males and -7.4 for females on placebo, and ranged from -4.2 to -3.6 for males and -12.4 to +0.2 for females in the cariprazine-treatment groups. In patients with bipolar mania (male, n = 570; female, n = 395), median prolactin changes were -0.2 for males and -1.1 for females on placebo and ranged from -2.1 to -3.0 for males and 0 to +1.8 for females in the cariprazine-treatment groups. Median decreases were also seen in the long-term studies of schizophrenia (range, -14.6 to -2.0) and bipolar mania (range, -0.8 to +1.9). In patients with bipolar depression (male, n = 485; female, n = 780), median prolactin changes were +0.3 for males and +0.7 for females on placebo and ranged from +0.4 to +0.5 for males and +3.0 to +3.1 for females in the cariprazine-treatment groups. CONCLUSION Treatment with cariprazine for schizophrenia or bipolar I disorder was associated with minimal effects on prolactin levels.
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Affiliation(s)
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
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10
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Hyperprolactinemia in Adults with Prader-Willi Syndrome. J Clin Med 2021; 10:jcm10163613. [PMID: 34441908 PMCID: PMC8396901 DOI: 10.3390/jcm10163613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/25/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental genetic disorder typically characterized by body composition abnormalities, hyperphagia, behavioural challenges, cognitive dysfunction, and hypogonadism. Psychotic illness is common, particularly in patients with maternal uniparental disomy (mUPD), and antipsychotic medications can result in hyperprolactinemia. Information about hyperprolactinemia and its potential clinical consequences in PWS is sparse. Here, we present data from an international, observational study of 45 adults with PWS and hyperprolactinemia. Estimated prevalence of hyperprolactinemia in a subset of centres with available data was 22%, with 66% of those related to medication and 55% due to antipsychotics. Thirty-three patients were men, 12 women. Median age was 29 years, median BMI 29.8 kg/m2, 13 had mUPD. Median prolactin was 680 mIU/L (range 329–5702). Prolactin levels were higher in women and patients with mUPD, with only 3 patients having severe hyperprolactinemia. Thyroid function tests were normal, 24 were treated with growth hormone, 29 with sex steroids, and 20 with antipsychotic medications. One patient had kidney insufficiency, and one a microprolactinoma. In conclusion, severe hyperprolactinemia was rare, and the most common aetiology of hyperprolactinemia was treatment with antipsychotic medications. Although significant clinical consequences could not be determined, potential negative long-term effects of moderate or severe hyperprolactinemia cannot be excluded. Our results suggest including measurements of prolactin in the follow-up of adults with PWS, especially in those on treatment with antipsychotics.
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11
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Besag FMC, Vasey MJ, Salim I. Is Adjunct Aripiprazole Effective in Treating Hyperprolactinemia Induced by Psychotropic Medication? A Narrative Review. CNS Drugs 2021; 35:507-526. [PMID: 33880739 DOI: 10.1007/s40263-021-00812-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/10/2023]
Abstract
Psychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assessed. Six RCTs, with a total of 609 patients, met inclusion criteria. Primary psychotropics included risperidone, haloperidol, paliperidone, fluphenazine and loxapine. Reductions in prolactin from baseline, before the introduction of aripiprazole, were significantly greater for adjunct aripiprazole than for adjunct placebo in all the studies (p = 0.04 to p < 0.0001). Normalisation of serum prolactin levels was significantly more likely with adjunct aripiprazole than adjunct placebo (p = 0.028 to p < 0.001, data from three studies). Improvement or resolution of HPRL-related symptoms (galactorrhoea, oligomenorrhoea, amenorrhoea and sexual dysfunction) were reported in three studies. Prolactin levels decreased in all case reports and in both of two open-label studies; they normalised in 30/41 patients (73.2%) in case studies and 12/29 (41.4%) in the open-label studies. Adjunct aripiprazole was statistically significantly effective in treating elevated serum prolactin levels in six RCTs. Evidence from case reports and open-label studies suggests a degree of effectiveness in most patients.
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 9 Rush Court, Bedford, MK40 3JT, UK. .,University College London, London, UK. .,King's College London, London, UK.
| | | | - Iffah Salim
- East London Foundation NHS Trust, Glen Road, Cherry Tree Way, Newham, London, E13 8SP, UK
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Levchenko A, Kanapin A, Samsonova A, Fedorenko OY, Kornetova EG, Nurgaliev T, Mazo GE, Semke AV, Kibitov AO, Bokhan NA, Gainetdinov RR, Ivanova SA. A genome-wide association study identifies a gene network associated with paranoid schizophrenia and antipsychotics-induced tardive dyskinesia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:110134. [PMID: 33065217 DOI: 10.1016/j.pnpbp.2020.110134] [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: 06/26/2020] [Revised: 09/10/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
In the present study we conducted a genome-wide association study (GWAS) in a cohort of 505 patients with paranoid schizophrenia (SCZ), of which 95 had tardive dyskinesia (TD), and 503 healthy controls. Using data generated by the PsychENCODE Consortium (PEC) and other bioinformatic databases, we revealed a gene network, implicated in neurodevelopment and brain function, associated with both these disorders. Almost all these genes are in gene or isoform co-expression PEC network modules important for the functioning of the brain; the activity of these networks is also altered in SCZ, bipolar disorder and autism spectrum disorders. The associated PEC network modules are enriched for gene ontology terms relevant to the brain development and function (CNS development, neuron development, axon ensheathment, synapse, synaptic vesicle cycle, and signaling receptor activity) and to the immune system (inflammatory response). Results of the present study suggest that orofacial and limbtruncal types of TD seem to share the molecular network with SCZ. Paranoid SCZ and abnormal involuntary movements that indicate the orofacial type of TD are associated with the same genomic loci on chromosomes 3p22.2, 8q21.13, and 13q14.2. The limbtruncal type of TD is associated with a locus on chromosome 3p13 where the best functional candidate is FOXP1, a high-confidence SCZ gene. The results of this study shed light on common pathogenic mechanisms for SCZ and TD, and indicate that the pathogenesis of the orofacial and limbtruncal types of TD might be driven by interacting genes implicated in neurodevelopment.
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Affiliation(s)
- Anastasia Levchenko
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, Saint Petersburg, Russia.
| | - Alexander Kanapin
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, Saint Petersburg, Russia
| | - Anastasia Samsonova
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, Saint Petersburg, Russia
| | - Olga Yu Fedorenko
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; National Research Tomsk Polytechnic University, Tomsk, Russia
| | - Elena G Kornetova
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; Siberian State Medical University, Tomsk, Russia
| | | | - Galina E Mazo
- Department of Endocrine Psychiatry, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia
| | - Arkadiy V Semke
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Alexander O Kibitov
- Department of Endocrine Psychiatry, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia; Laboratory of Molecular Genetics, Serbsky National Medical Research Center on Psychiatry and Addictions, Moscow, Russia
| | - Nikolay A Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; Siberian State Medical University, Tomsk, Russia; National Research Tomsk State University, Tomsk, Russia
| | - Raul R Gainetdinov
- Institute of Translational Biomedicine, Saint Petersburg State University, Saint Petersburg, Russia
| | - Svetlana A Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; National Research Tomsk Polytechnic University, Tomsk, Russia; Siberian State Medical University, Tomsk, Russia
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Galactorrhea during antipsychotic treatment: results from AMSP, a drug surveillance program, between 1993 and 2015. Eur Arch Psychiatry Clin Neurosci 2021; 271:1425-1435. [PMID: 33768297 PMCID: PMC8563638 DOI: 10.1007/s00406-021-01241-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/12/2021] [Indexed: 11/25/2022]
Abstract
Galactorrhea is a well-known adverse drug reaction (ADR) of numerous antipsychotic drugs (APD) and is often distressing for those affected. Methodological problems in the existing literature make it difficult to determine the prevalence of symptomatic hyperprolactinemia in persons treated with APDs. Consequently, a large sample of patients exposed to APDs is needed for more extensive evaluation. Data on APD utilization and reports of galactorrhea caused by APDs were analyzed using data from an observational pharmacovigilance program in German-speaking countries-Arzneimittelsicherheit in der Psychiatrie (AMSP)-from 1993 to 2015. 320,383 patients (175,884 female inpatients) under surveillance were treated with APDs for schizophrenia and other indications. A total of 170 events of galactorrhea caused by APDs were identified (0.97 cases in 1000 female inpatient admissions). Most cases occurred during the reproductive age with the highest incidence among patients between 16 and 30 years (3.81 cases in 1000 inpatients). The APDs that were most frequently imputed alone for inducing galactorrhea were risperidone (52 cases and 0.19% of all exposed inpatients), amisulpride (30 resp. 0.48%), and olanzapine (13 resp. 0.05%). In three cases, quetiapine had a prominent role as a probable cause for galactorrhea. High dosages of the imputed APDs correlated with higher rates of galactorrhea. Galactorrhea is a severe and underestimated condition in psychopharmacology. While some APDs are more likely to cause galactorrhea, we identified a few unusual cases. This highlights the importance of alertness in clinical practice and of taking a patient's individual situation into consideration.
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Chen M, Wang M, Chen Y, He J, Zou J, Meng J, Zhao L, Wu J. Comparative assessment of effect of malt with different bud length on prolactin in hyperprolactinemia rat. BRAZ J PHARM SCI 2021. [DOI: 10.1590/s2175-979020200004181104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Min Chen
- The Third Hospital of Wu-han, China
| | - Mingyan Wang
- College of pharmacy of Xin Jiang Medical University, China
| | | | - Jin He
- Wuhan JinYinTan Hospital, China
| | - Jili Zou
- The Third Hospital of Wu-han, China
| | | | - Lin Zhao
- The Third Hospital of Wu-han, China
| | - Jinhu Wu
- The Third Hospital of Wu-han, China
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15
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Fedorenko OY, Paderina DZ, Loonen AJM, Pozhidaev IV, Boiko AS, Kornetova EG, Bokhan NA, Wilffert B, Ivanova SA. Association of ANKK1 polymorphism with antipsychotic-induced hyperprolactinemia. Hum Psychopharmacol 2020; 35:e2737. [PMID: 32383805 PMCID: PMC7507142 DOI: 10.1002/hup.2737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Schizophrenia is a severe highly heritable mental disorder. Genetic polymorphisms of dopaminergic pathways are related to pathogenesis of drug response. Hyperprolactinemia (HPRL), a common adverse effect of antipsychotics, is attributed to blockade of dopamine D2 receptors. Ankyrin Repeat and Kinase Domain containing 1 (ANKK1) gene is closely related to Dopamine Receptor D2 type (DRD2) gene functioning. We examined whether the functional polymorphism rs2734849 in the ANKK1 gene is associated with antipsychotic-induced HPRL. METHODS We recruited 446 patients with schizophrenia from among the Russian population of the Siberian region. The polymorphism rs2734849 in the ANKK1 gene was genotyped with The MassARRAY® Analyzer 4 by Agena Bioscience™, using the kit SEQUENOM Consumables iPLEXGold 384. Genotype and allele frequencies were compared between groups of schizophrenia patients with and without HPRL using the χ2 test. RESULTS A comparison between schizophrenia patients with and without HPRL revealed significantly higher frequency of the C allele of the polymorphic variant rs2734849 in the ANKK1 gene in patients with HPRL as compared to the patients without it (χ2 = 3.70; p = .05; odds ratio [OR] = 1.30 [0.99-1.69]). CONCLUSION The functional polymorphism rs2734849 in the ANKK1 gene was associated with HPRL in patients with schizophrenia.
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Affiliation(s)
- Olga Yu. Fedorenko
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Division for Control and Diagnostics, School of Non‐Destructive Testing and SecurityNational Research Tomsk Polytechnic UniversityTomskRussia
| | - Diana Z. Paderina
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Department of Cytology and Genetics, National Research Tomsk State UniversityTomskRussia
| | - Anton J. M. Loonen
- PharmacoTherapy, ‐Epidemiology and ‐Economics, Groningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands,Policy Office for Quality and Innovation of Care (BZI), GGZ Westelijk Noord‐BrabantHalsterenThe Netherlands
| | - Ivan V. Pozhidaev
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Department of Cytology and Genetics, National Research Tomsk State UniversityTomskRussia
| | - Anastasiia S. Boiko
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia
| | - Elena G. Kornetova
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Hospital, Siberian State Medical UniversityTomskRussia
| | - Nikolay A. Bokhan
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Department of Psychotherapy and Psychological Counseling, National Research Tomsk State UniversityTomskRussia,Department of Psychiatry, Addictology and Psychotherapy, Siberian State Medical UniversityTomskRussia
| | - Bob Wilffert
- PharmacoTherapy, ‐Epidemiology and ‐Economics, Groningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands,Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Svetlana A. Ivanova
- Mental Health Research InstituteTomsk National Research Medical Center of Russian Academy of SciencesTomskRussia,Division for Control and Diagnostics, School of Non‐Destructive Testing and SecurityNational Research Tomsk Polytechnic UniversityTomskRussia,Department of Psychiatry, Addictology and Psychotherapy, Siberian State Medical UniversityTomskRussia
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16
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Geers LM, Pozhidaev IV, Ivanova SA, Freidin MB, Schmidt AF, Cohen D, Boiko AS, Paderina DZ, Fedorenko OY, Semke AV, Bokhan NA, Wilffert B, Kosterink JGW, Touw DJ, Loonen AJM. Association between 8 P-glycoprotein (MDR1/ABCB1) gene polymorphisms and antipsychotic drug-induced hyperprolactinaemia. Br J Clin Pharmacol 2020; 86:1827-1835. [PMID: 32198935 PMCID: PMC7444793 DOI: 10.1111/bcp.14288] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/05/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Hyperprolactinaemia, a common adverse effect of antipsychotic drugs, is primarily linked to blockade of dopamine D2 receptors in the pituitary gland. Certain antipsychotic drugs, such as, for example risperidone and paliperidone, are more likely to induce hyperprolactinaemia compared to others. This effect is probably caused by a relatively high blood/brain concentration ratio, a consequence of being a substrate of P‐glycoprotein. Genetic variants of P‐glycoprotein with changed functional activity might influence the potential of risperidone and paliperidone to cause hyperprolactinaemia as the altered blood/brain concentration ratio would lead to a reduced therapeutic drug level within essential brain areas making dose adaptations necessary. This increases exposure of dopamine D2 receptors within the pituitary gland. Aims To investigate possible associations between MDR1/ABCB1 gene polymorphisms and antipsychotic drug‐induced hyperprolactinaemia in Russian patients with schizophrenia and to determine possible differences between risperidone/paliperidone and other antipsychotics. Methods In total, 446 patients with schizophrenia were included from 3 psychiatric hospitals in Siberia. Blood samples were obtained in a cross‐sectional study design for DNA extraction and prolactin measurement. Associations between hyperprolactinaemia and 8 MDR1/ABCB1 gene‐polymorphisms were assessed using logistic regression analysis accounting for covariates. The analysis was repeated in a patient subgroup using risperidone or paliperidone. Results We did not observe an association between any of the 8 single nucleotide polymorphisms and the prevalence of antipsychotic‐induced hyperprolactinaemia in the total patient population. However, in the risperidone/paliperidone subgroup, the single nucleotide polymorphism rs2032582 (G2677T) was found to be negatively associated with risperidone/paliperidone‐induced hyperprolactinaemia. Conclusion This study revealed a significant association between the ABCB1 gene polymorphism rs2032582 (G2677T) and risperidone/paliperidone‐induced hyperprolactinaemia.
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Affiliation(s)
- Lisanne M Geers
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivan V Pozhidaev
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation.,National Research Tomsk State University, Tomsk, Russian Federation
| | - Svetlana A Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation.,National Research Tomsk Polytechnic University, Tomsk, Russian Federation.,Siberian State Medical University, Tomsk, Russian Federation
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology, School of Live Course Sciences, King's College London, London, UK.,Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Amand F Schmidt
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
| | - Dan Cohen
- FACT-team Heerhugowaard, Department of Community psychiatry, Mental Health Organization North-Holland North, The Netherlands
| | - Anastasiia S Boiko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Diana Z Paderina
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation.,National Research Tomsk State University, Tomsk, Russian Federation
| | - Olga Yu Fedorenko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation.,National Research Tomsk Polytechnic University, Tomsk, Russian Federation
| | - Arkadiy V Semke
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation.,Siberian State Medical University, Tomsk, Russian Federation
| | - Nikolay A Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russian Federation.,National Research Tomsk State University, Tomsk, Russian Federation.,Siberian State Medical University, Tomsk, Russian Federation
| | - Bob Wilffert
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Pharmacy, PharmacoTherapy, - Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Jos G W Kosterink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Pharmacy, PharmacoTherapy, - Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Groningen Research Institute of Pharmacy, Department of Pharmaceutical Analysis, University of Groningen, Groningen, The Netherlands
| | - Anton J M Loonen
- Groningen Research Institute of Pharmacy, PharmacoTherapy, - Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands.,GGZ Westelijk Noord-Brabant, Halsteren, The Netherlands
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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18
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Allen K, Baban A, Munjiza J, Pappa S. Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review. J Sex Med 2019; 16:1978-1987. [PMID: 31585803 DOI: 10.1016/j.jsxm.2019.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sexual dysfunction is one of the most frequently occurring side-effects of antipsychotic medication, impacting both quality of life and adherence to treatment. Despite this, limited evidence-based guidance on treatment options is available. AIM To synthesize and analyze the evidence on management of antipsychotic-related sexual dysfunction, specifically taking note of the more recently developed antipsychotics that have been incorporated in studies over the past decade. METHODS EMBASE, Medline, and PsychINFO databases were searched using search terms related to sexual or erectile dysfunction, treatments, and antipsychotics. 2 reviewers independently assessed papers for the inclusion criteria for randomized controlled trials (RCTs) of treatments for antipsychotic-related sexual dysfunction, including adjunctive medications and a switch of antipsychotic. Studies were excluded if participants did not have recorded sexual dysfunction at baseline. MAIN OUTCOME MEASURE The primary outcome measure was any change in sexual function. RESULTS 6 RCTs were identified, all of which investigated different interventions; hence, it was not possible to synthesize the data quantitatively. Results were overall limited by small sample size, brief treatment duration, and the potential for bias. 2 studies, one assessing adjunctive sildenafil and the other adjunctive aripiprazole, reported a reduction in antipsychotic-related sexual dysfunction. CLINICAL IMPLICATIONS Due to the lack of high-quality data, no clinical recommendations can be made. STRENGTHS & LIMITATIONS A comprehensive search strategy was used with an extensive number of relevant search terms including "erectile dysfunction" and newer antipsychotics such as aripiprazole. In light of evidence that prolactin is not a reliable marker for sexual dysfunction, this review focused its inclusion criteria on participants presenting with sexual dysfunction rather than with hyperprolactinemia, which should give its recommendations more validity. However, only 6 RCTs were identified, and results were overall limited by small sample size, brief treatment duration, and the potential for bias. CONCLUSION Our findings highlight the paucity of high-quality research in this area, and conjecture that it may be difficult to recruit participants with antipsychotic-related sexual dysfunction. Future research may be necessary to unlock and address these difficulties. Furthermore, fully powered future studies should focus on the management of sexual dysfunction rather than the surrogate marker of hyperprolactinemia. Allen K, Baban A, Munjiza J, et al. Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review. J Sex Med 2019;16:1978-1987.
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Affiliation(s)
| | - Alan Baban
- Central and North West London NHS Foundation Trust, London, UK
| | - Jasna Munjiza
- Central and North West London NHS Foundation Trust, London, UK; Centre for Psychiatry, Faculty of Medicine, Imperial College London, London, UK
| | - Sofia Pappa
- West London NHS Trust, London, UK; Centre for Psychiatry, Faculty of Medicine, Imperial College London, London, UK
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19
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Osmanova DZ, Freidin MB, Fedorenko OY, Pozhidaev IV, Boiko AS, Vyalova NM, Tiguntsev VV, Kornetova EG, Loonen AJM, Semke AV, Wilffert B, Bokhan NA, Ivanova SA. A pharmacogenetic study of patients with schizophrenia from West Siberia gets insight into dopaminergic mechanisms of antipsychotic-induced hyperprolactinemia. BMC MEDICAL GENETICS 2019; 20:47. [PMID: 30967134 PMCID: PMC6454588 DOI: 10.1186/s12881-019-0773-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hyperprolactinemia (HPRL) is a classical side effect of antipsychotic drugs primarily attributed to blockade of dopamine D2 receptors (DRD2s) on the membranes of lactotroph cells within the pituitary gland. Certain antipsychotic drugs, e.g. risperidone, are more likely to induce HPRL because of relative accumulation within the adenohypophysis. Nevertheless, due to competition for pituitary DRD2s by high dopamine levels may limit antipsychotic-induced HPRL. Moreover, the activity of prolactin-producing lactotrophs also depends on other hormones which are regulated by the extra-pituitary activity of dopamine receptors, dopamine transporters, enzymes of neurotransmitter metabolism and other factors. Polymorphic variants in the genes coding for these receptors and proteins can have functional significance and influence on the development of hyperprolactinemia. METHODS A set of 41 SNPs of genes for dopamine receptors DRD1, DRD2, DRD3, DRD4, the dopamine transporter SLC6A3 and dopamine catabolizing enzymes MAOA and MAOB was investigated in a population of 446 Caucasians (221 males/225 females) with a clinical diagnosis of schizophrenia (according to ICD-10: F20) with and without HPRL who were treated with classical and/or atypical antipsychotic drugs. Additive genetic model was tested and the analysis was carried out in the total group and in subgroup stratified by the use of risperidone/paliperidone. RESULTS One statistically significant association between polymorphic variant rs1799836 of MAOB gene and HPRL in men was found in the total group. Furthermore, the rs40184 and rs3863145 variants in SLC6A3 gene appeared to be associated with HPRL in the subgroup of patients using the risperidone/paliperidone, but not with HPRL induced by other antipsychotic drugs. CONCLUSIONS Our results indicate that genetic variants of MAOB and SLC6A3 may have consequences on the modulation of prolactin secretion. A further search for genetic markers associated with the development of antipsychotic-related hyperprolactinemia in schizophrenic patients is needed.
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Affiliation(s)
- Diana Z. Osmanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
- National Research Tomsk State University, Lenin Avenue, Tomsk, Russian Federation 36
| | - Maxim B. Freidin
- Department of Twin Research and Genetic Epidemiology, School of Live Course Sciences, King’s College London, Lambeth Palace Road, London, SE1 7EH UK
- Research Institute of Medical Genetics, Tomsk National Research Medical Center of the Russian Academy of Sciences, Naberezhnaya Ushaiki str, Tomsk, Russian Federation 10
| | - Olga Yu. Fedorenko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
- National Research Tomsk Polytechnic University, Lenin Avenue, Tomsk, Russian Federation 30
| | - Ivan V. Pozhidaev
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
- National Research Tomsk State University, Lenin Avenue, Tomsk, Russian Federation 36
| | - Anastasiia S. Boiko
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
| | - Natalia M. Vyalova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
| | - Vladimir V. Tiguntsev
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
| | - Elena G. Kornetova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
| | - Anton J. M. Loonen
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, 4661 AA Halsteren, The Netherlands
| | - Arkadiy V. Semke
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
| | - Bob Wilffert
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Nikolay A. Bokhan
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
- National Research Tomsk State University, Lenin Avenue, Tomsk, Russian Federation 36
| | - Svetlana A. Ivanova
- Mental Health Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences, Aleutskaya str., 4, Tomsk, Russian Federation 634014
- National Research Tomsk Polytechnic University, Lenin Avenue, Tomsk, Russian Federation 30
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Abstract
SummaryMedications prescribed by psychiatrists are known to elevate serum prolactin levels, but hyperprolactinaemia remains underrecognised, as the adverse effects of an elevated prolactin are mostly not visible. Hyperprolactinaemia can lead to adverse health outcomes, so clinicians need not only to be alert to its symptoms, but to manage the consequences as well. In this article we provide a brief overview of prolactin physiology, regulation and function. We list various factors that can lead to elevated serum prolactin. We discuss the interpretation of blood results and the management of psychotropic-induced hyperprolactinaemia. We include a flow diagram to assist clinicians in decision-making in the clinical management of hyperprolactinaemia.Learning Objectives• Understand prolactin physiology and regulation• Understand hyperprolactinaemia and its causes• Know the consequences of hyperprolactinaemia and appropriately manage it in clinical practice
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22
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, Del Pino-Montes J, García-Escudero MA, García-Rizo C, González-Pinto A, Hernández AI, Martín-Carrasco M, Mayoral-Cleries F, Mayoral-van Son J, Mories MT, Pachiarotti I, Pérez J, Ros S, Vieta E. Multidisciplinary consensus on the therapeutic recommendations for iatrogenic hyperprolactinemia secondary to antipsychotics. Front Neuroendocrinol 2017; 45:25-34. [PMID: 28235557 DOI: 10.1016/j.yfrne.2017.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 01/08/2023]
Abstract
Hyperprolactinemia is an underappreciated/unknown adverse effects of antipsychotics. The consequences of hyperprolactinemia compromise therapeutic adherence and can be serious. We present the consensus recommendations made by a group of experts regarding the management of antipsychotic-induced hyperprolactinemia. The current consensus was developed in 3 phases: 1, review of the scientific literature; 2, subsequent round table discussion to attempt to reach a consensus among the experts; and 3, review by all of the authors of the final conclusions until reaching a complete consensus. We include recommendations on the appropriate time to act after hyperprolactinemia detection and discuss the evidence on available options: decreasing the dose of the antipsychotic drug, switching antipsychotics, adding aripiprazole, adding dopaminergic agonists, and other type of treatment. The consensus also included recommendations for some specific populations such as patients with a first psychotic episode and the pediatric-youth population, bipolar disorder, personality disorders and the elderly population.
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Affiliation(s)
- Ángel L Montejo
- Neurosciences Area, Instituto de Biomedicina de Salamanca (IBSAL), University of Salamanca, Psychiatry Department, University Hospital of Salamanca, Salamanca, Spain.
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - José L Carrasco
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Benidicto Crespo-Facorro
- Department of Medicine & Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Santander, Spain
| | - Juan J Cruz
- Department of Medical Oncology, Instituto de Biomedicina de Salamanca (IBSAL), University of Salamanca, University Hospital of Salamanca, Salamanca, Spain
| | | | | | - Clemente García-Rizo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Ana González-Pinto
- International Mood Disorders Research Centre, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Santiago Apóstol, University of the Basque Country, Vitoria, Spain
| | - Ana I Hernández
- FEA Psiquiatría, Red de Salud Mental de Guipúzcoa, San Sebastián, Spain
| | - Manuel Martín-Carrasco
- Institute of Psychiatric Research, Mª Josefa Recio Foundation, Bilbao, Spain; Psychiatry Clinic Padre Menni, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Pamplona, Spain
| | - Fermín Mayoral-Cleries
- University Regional Hospital of Malaga, Biomedical Research Institute (IBIMA), Malaga, Spain
| | | | - M Teresa Mories
- Endocrinology and Nutrition Department, University Hospital of Salamanca, Salamanca, Spain
| | - Isabella Pachiarotti
- Bipolar Disorders Program, Psychiatry Department, Hospital Clinic, University of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Jesús Pérez
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Salvador Ros
- International Institute of Applied Neurosciences, Barcelona, Spain
| | - Eduard Vieta
- Bipolar Disorders Program, Psychiatry Department, Hospital Clinic, University of Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
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Ivanova SA, Osmanova DZ, Freidin MB, Fedorenko OY, Boiko AS, Pozhidaev IV, Semke AV, Bokhan NA, Agarkov AA, Wilffert B, Loonen AJM. Identification of 5-hydroxytryptamine receptor gene polymorphisms modulating hyperprolactinaemia in antipsychotic drug-treated patients with schizophrenia. World J Biol Psychiatry 2017; 18:239-246. [PMID: 27654063 DOI: 10.1080/15622975.2016.1224926] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Hyperprolactinaemia (HPRL) is a classical side effect of antipsychotic drugs primarily attributed to blockade of dopamine D2 subtype receptors in the pituitary gland. Although dopamine is considered the primary factor inhibiting prolactin release, the activity of prolactin-producing lactotrophs is also regulated by the secretagogues thyrotrophin releasing hormone, vasoactive intestinal polypeptide and serotonin (5-hydroxytryptamine; 5-HT). METHODS We describe the association between HPRL and a set of 29 SNPs from 5-HT receptor genes HTR1A, HTR1B, HTR2A, HTR2C, HTR3A, HTR3B and HTR6 in a population of 446 Caucasians (221 males/225 females) with a clinical diagnosis of schizophrenia (according to ICD-10: F20) who were treated with classical and/or atypical antipsychotic drugs. RESULTS None of the studied autosomal markers were found to be associated with HPRL. However, a significant association was established between various HTR2C polymorphisms and HPRL. CONCLUSIONS This study revealed an association between HPRL and X-chromosome haplotypes comprised of the rs569959 and rs17326429 polymorphisms.
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Affiliation(s)
- Svetlana A Ivanova
- a Mental Health Research Institute , Tomsk , Russian Federation.,b National Research Tomsk Polytechnic University , Tomsk , Russian Federation
| | - Diana Z Osmanova
- a Mental Health Research Institute , Tomsk , Russian Federation.,c National Research Tomsk State University , Tomsk , Russian Federation
| | - Maxim B Freidin
- d Department of Twin Research and Genetic Epidemiology , King's College London , London , UK.,e Research Institute for Medical Genetics , Tomsk , Russian Federation
| | - Olga Yu Fedorenko
- a Mental Health Research Institute , Tomsk , Russian Federation.,b National Research Tomsk Polytechnic University , Tomsk , Russian Federation
| | | | - Ivan V Pozhidaev
- a Mental Health Research Institute , Tomsk , Russian Federation.,c National Research Tomsk State University , Tomsk , Russian Federation
| | - Arkadiy V Semke
- a Mental Health Research Institute , Tomsk , Russian Federation
| | - Nikolay A Bokhan
- a Mental Health Research Institute , Tomsk , Russian Federation.,c National Research Tomsk State University , Tomsk , Russian Federation
| | | | - Bob Wilffert
- f Department of Pharmacy , University of Groningen , Groningen , The Netherlands.,g Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Anton J M Loonen
- g Department of Clinical Pharmacy and Pharmacology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,h GGZ Westelijk Noord-Brabant , Bergen op Zoom , The Netherlands
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rpsmen.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Introduction: Antipsychotics represent a large portion of the psychotropics that may induce hyperprolactinemia. Clinical psychiatric pharmacists must be adept in stratifying the relative risk of hyperprolactinemia among psychotropics, identifying patient risk factors, recognizing differential diagnoses, and recommending therapeutic alternatives and treatment strategies. High-potency, typical antipsychotics are more likely to elevate prolactin although exceptions to the rule exist. Methods: A literature search of PubMed and Google Scholar was performed to identify English language articles on the treatment of antipsychotic-induced hyperprolactinemia in humans. Methodological rigor is summarized for compiled studies in addition to feasibility and limitations of application to clinical practice. Results: There is an absence of robust evidence for the management of antipsychotic-induced hyperprolactinemia. Among the pharmacological treatments studied, aripiprazole (switching or augmentation) possessed the strongest evidence. Pharmacological treatments with less evidence encompassed dose reduction, switching to lower potency antipsychotics, and adding dopamine agonists. To date, no head-to-head studies have been published on the above approaches. Discussion: Atypical antipsychotics with low affinity for dopamine (D2) receptors, such as olanzapine, are logical alternatives for the patient experiencing drug-induced hyperprolactinemia. When augmentation is clinically preferred to switching, a viable option is the addition of a full or partial dopamine agonist, such as bromocriptine or aripiprazole, respectively. Patient-specific risk of psychiatric decompensation and the severity of symptomatic hyperprolactinemia should be weighed when formulating treatment strategies.
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Affiliation(s)
- Ashley Tewksbury
- Pharmacist, Clinical Specialist Psychiatry, Lutheran Hospital, Cleveland Clinic, Cleveland, Ohio,
| | - Amy Olander
- PharmD Candidate, The Ohio State University College of Pharmacy, Columbus, Ohio
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Krysiak R, Kowalcze K, Szkrobka W, Okopien B. The effect of metformin on prolactin levels in patients with drug-induced hyperprolactinemia. Eur J Intern Med 2016; 30:94-98. [PMID: 26858210 DOI: 10.1016/j.ejim.2016.01.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/29/2015] [Accepted: 01/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND In bromocriptine-treated hyperprolactinemic patients with impaired glucose tolerance, metformin was found to reduce plasma levels of prolactin. No previous study has investigated its impact on plasma prolactin in patients with drug-induced hyperprolactinemia. METHODS The study included 20 women with antipsychotic-induced hyperprolactinemia and 12 normoprolactinemic women, who, because of coexisting glucose metabolism abnormalities, were treated for 6months with metformin. Hyperprolactinemic patients with prediabetes received moderate doses of metformin (1.7g daily), while hyperprolactinemic and normoprolactinemic patients with type 2 diabetes were treated with high-dose metformin (2.55-3g daily). Fasting plasma glucose levels, the homeostatic model assessment 1 of insulin resistance ratio (HOMA1-IR), glycated hemoglobin, as well as plasma levels of prolactin, thyrotropin, adrenocorticotropic hormone and insulin-like growth factor-1 were assessed at baseline and after 6months of treatment. RESULTS Despite reducing plasma glucose, HOMA1-IR, and glycated hemoglobin in all treatment groups, metformin decreased prolactin levels only if given at high doses to patients with elevated prolactin levels. No changes in thyrotropin, adrenocorticotropic hormone, and insulin-like growth factor-1 were observed in any treatment groups. CONCLUSIONS The obtained results suggest that the effect of metformin on plasma prolactin depends on its dose and is observed only in patients with elevated levels of this hormone.
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Affiliation(s)
- Robert Krysiak
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland.
| | - Karolina Kowalcze
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Witold Szkrobka
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
| | - Boguslaw Okopien
- Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, Medyków 18, 40-752 Katowice, Poland
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, Del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 9:158-73. [PMID: 26927534 DOI: 10.1016/j.rpsm.2015.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/28/2015] [Accepted: 11/16/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Iatrogenic hyperprolactinaemia (IHPRL) has been more frequently related to some antipsychotic drugs that provoke an intense blockade of dopamine D2 receptors. There is a wide variation in clinical practice, and perhaps some more awareness between clinicians is needed. Due to the high frequency of chronic treatment in severe mental patients, careful attention is recommended on the physical risk. IHPRL symptoms could be underestimated without routine examination. METHODOLOGY An intense scientific literature search was performed in order to draw up a multidisciplinary consensus, including different specialists of psychiatry, endocrinology, oncology and internal medicine, and looking for a consensus about clinical risk and detection of IHPRL following evidence-based medicine criteria levels (EBM I- IV). RESULTS Short-term symptoms include amenorrhea, galactorrhoea, and sexual dysfunction with decrease of libido and erectile difficulties related to hypogonadism. Medium and long-term symptoms related to oestrogens are observed, including a decrease bone mass density, hypogonadism, early menopause, some types of cancer risk increase (breast and endometrial), cardiovascular risk increase, immune system disorders, lipids, and cognitive dysfunction. Prolactin level, gonadal hormones and vitamin D should be checked in all patients receiving antipsychotics at baseline although early symptoms (amenorrhea-galactorrhoea) may not be observed due to the risk of underestimating other delayed symptoms that may appear in the medium term. Routine examination of sexual dysfunction is recommended due to possible poor patient tolerance and low compliance. Special care is required in children and adolescents, as well as patients with PRL levels >50ng/ml (moderate hyperprolactinaemia). A possible prolactinoma should be investigated in patients with PRL levels >150ng/ml, with special attention to patients with breast/endometrial cancer history. Densitometry should be prescribed for males >50 years old, amenorrhea>6 months, or early menopause to avoid fracture risk.
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Affiliation(s)
- Ángel L Montejo
- Área de Neurociencias, Instituto de Biomedicina de Salamanca (IBSAL), Universidad de Salamanca, Servicio de Psiquiatría, Hospital Universitario de Salamanca, España.
| | - Celso Arango
- Departamento de Psiquiatría Infanto-Juvenil, Hospital General Universitario Gregorio Marañón (IiSGM). Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Miguel Bernardo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - José L Carrasco
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, CIBERSAM, Madrid, España
| | - Benedicto Crespo-Facorro
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria. Hospital Universitario Marqués de Valdecilla, IDIVAL, CIBERSAM, Santander, España
| | - Juan J Cruz
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Universidad de Salamanca (IBSAL), España
| | - Javier Del Pino
- Servicio Medicina Interna, Hospital Clínico Universitario, Universidad de Salamanca, España
| | | | - Clemente García Rizo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - Ana González-Pinto
- International Mood Disorders Research Centre, CIBERSAM, Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España
| | - Ana I Hernández
- FEA Psiquiatría, Red de Salud Mental de Guipúzcoa, San Sebastián, España
| | - Manuel Martín Carrasco
- Instituto de Investigaciones Psiquiátricas, Fundación María Josefa Recio, Bilbao, España; Clínica Psiquiátrica Padre Menni, CIBERSAM, Pamplona, España
| | - Fermin Mayoral Cleries
- UGC Salud Mental, Hospital Regional Universitario, Instituto de Biomedicina de Málaga, Málaga, España
| | | | - M Teresa Mories
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Salamanca, España
| | - Isabella Pachiarotti
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
| | - Salvador Ros
- Instituto Internacional de Neurociencias Aplicadas, Barcelona, España
| | - Eduard Vieta
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
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Zamani Z, Zare S, Sadrkhanlou R, Ahmadi A, Movahed E. Chlorpromazine-Induced Hyperprolactinemia on Rat's Uterus. IRANIAN BIOMEDICAL JOURNAL 2015; 19:226-32. [PMID: 26239213 PMCID: PMC4649858 DOI: 10.7508/ibj.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Hyperprolactinemia is a common side effect of antipsychotic drugs that requires further investigation. The current study was designed to evaluate dose-dependent effect of chlorpromazine (CPZ) on hormonal changes and uterine horn histological structure in rats. Moreover, the mammary glands were analyzed to show hyperprolactinemia-induced histological changes. Methods: Albino Wistar rats (n = 32) were divided into four groups. The first group was set as a control. In the three drug-treated groups (eight rats in each group), CPZ was administered by a gavage at doses of 3, 10, and 30 mg/kg/day for 28 days. One day after the last administration of the drug, the animals were sacrificed. Histopathological and histomorphometrical analyses of the uterine horns and mammary glands were carried out to evaluate dose-dependent effect of CPZ on histological structure. Serum levels of prolactin (PRL), estradiol, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were also evaluated. Results: Remarkable (P < 0.05) elevation was observed in CPZ-administrated animals' uterine horn endometrium, myometrium, and perimetrium thicknesses, and the mammary glands were observed with galactorrhea features. The serum level of progesterone and PRL significantly (P < 0.05) increased, while the serum concentration of LH, FSH, and estradiol was notably (P < 0.05) decreased depending on administrated CPZ dose. No histological and biological changes were occurred in the control animals. Conclusion: The present findings suggest that CPZ-induced disturbances not only depend on PRL level and increased PRL level largely depends on administrated doses of the CPZ.
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Affiliation(s)
- Zahra Zamani
- Dept. of Biology, Faculty of Science, Urmia University, Urmia, Iran
| | - Samad Zare
- Dept. of Biology, Faculty of Science, Urmia University, Urmia, Iran
| | - Rajabali Sadrkhanlou
- Laboratory of Embryology, Dept. of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Abbas Ahmadi
- Laboratory of Embryology, Dept. of Basic Science, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Elham Movahed
- Dept. of Biology, Faculty of Science, Urmia University, Urmia, Iran
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Chen JX, Su YA, Bian QT, Wei LH, Zhang RZ, Liu YH, Correll C, Soares JC, Yang FD, Wang SL, Zhang XY. Adjunctive aripiprazole in the treatment of risperidone-induced hyperprolactinemia: A randomized, double-blind, placebo-controlled, dose-response study. Psychoneuroendocrinology 2015; 58:130-40. [PMID: 25981348 DOI: 10.1016/j.psyneuen.2015.04.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/27/2015] [Accepted: 04/16/2015] [Indexed: 01/28/2023]
Abstract
Hyperprolactinemia is an unwanted adverse effect associated with several antipsychotics. The addition of partial dopamine receptor agonist aripiprazole may attenuate antipsychotic-induced hyperprolactinemia effectively. However, the ideal dosing regimen for this purpose is unknown. We aimed to evaluate the dose effects of adjunctive treatment with aripiprazole on prolactin levels and hyperprolactinemia in schizophrenia patients. Stable subjects 18-45 years old with schizophrenia and hyperprolactinemia (i.e., >24 ng/ml for females and >20 ng/ml for males) were randomly assigned to receive 8 weeks of placebo (n=30) or oral aripiprazole 5mg/day (n=30), 10mg/day (n=29), or 20mg/day (n=30) added on to fixed dose risperidone treatment. Serum prolactin levels were measured at baseline and after 2, 4 and 8 weeks; clinical symptoms and side effects were assessed at baseline and week 8 using the Positive and Negative Syndrome Scale, Clinical Global Impressions Severity scale, Barnes Akathisia Scale, Simpson-Angus Scale and UKU Side Effects Rating Scale. Of 119 randomized patients, 107 (89.9%) completed the 8-week study. At study end, all three aripiprazole doses resulted in significantly lower prolactin levels (beginning at week 2), higher response rates (≥30% prolactin reduction) and higher prolactin normalization rates than placebo. Effects were significantly greater in the 10 and 20mg/day groups than the 5mg/day group. No significant changes were observed in any treatment groups regarding psychopathology and adverse effect ratings. Adjunctive aripiprazole treatment was effective and safe for resolving risperidone-induced hyperprolactinemia, producing significant and almost maximal improvements by week 2 without significant effects on psychopathology and side effects.
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Affiliation(s)
- Jing-Xu Chen
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Yun-Ai Su
- Peking University Sixth Hospital/Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Qing-Tao Bian
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Li-He Wei
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Rong-Zhen Zhang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Yan-Hong Liu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Christoph Correll
- The Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Fu-De Yang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Shao-Li Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China
| | - Xiang-Yang Zhang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, China; Department of Psychiatry and Behavioral Sciences, Harris County Psychiatric Center, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Citrome L, Kamat SA, Sapin C, Baker RA, Eramo A, Ortendahl J, Gutierrez B, Hansen K, Bentley TGK. Cost-effectiveness of aripiprazole once-monthly compared with paliperidone palmitate once-monthly injectable for the treatment of schizophrenia in the United States. J Med Econ 2014; 17:567-76. [PMID: 24758296 DOI: 10.3111/13696998.2014.917089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop a decision-analytic model to estimate the cost-effectiveness of initiating maintenance treatment with aripiprazole once-monthly (AOM) vs paliperidone long-acting injectable (PLAI) once-monthly among patients with schizophrenia in the US. METHODS A decision-analytic model was developed to evaluate a hypothetical cohort of patients initiating maintenance treatment with AOM or PLAI. Rates of relapse, adverse events (AEs), and direct medical costs were estimated for 1 year. Patients either remained on initial treatment or discontinued treatment due to lack of efficacy, AEs, or other reasons, including non-adherence. Data from placebo-controlled pivotal trials and product prescribing information (PI) were used to estimate treatment efficacy and AEs. Analyses were performed assuming dosing of clinical trials, real-world practice, PIs, and highest therapeutic dose available, because of variation in practice settings. The main outcome of interest was incremental cost per schizophrenia hospitalization averted with AOM vs PLAI. RESULTS Based on placebo-controlled pivotal trials' dosing, AOM improved clinical outcomes by reducing schizophrenia relapses vs PLAI (0.181 vs 0.277 per person per year [pppy]) at an additional cost of US$1276 pppy, resulting in an incremental cost-effectiveness ratio (ICER) of US$13,280/relapse averted. When PI dosing was assumed, this ICER increased to US$19,968/relapse averted. When real-world dosing and highest available dosing were assumed, AOM was associated with fewer relapses and lower overall treatment costs vs PLAI. CONCLUSIONS AOM consistently provided favorable clinical benefits. Under various dosing scenarios, AOM results indicated fewer relapses at lower overall costs or a reasonable cost-effectiveness threshold (i.e., less than the cost of a hospitalization relapse) vs PLAI. Given the heterogeneous nature of schizophrenia and variability in treatment response, health plans may consider open access for treatments like AOM. Since model inputs were based on data from separate placebo-controlled trials, generalization of results to the real-world setting is limited.
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Affiliation(s)
- Leslie Citrome
- Department of Psychiatry & Behavioral Sciences, New York Medical College , Valhalla, NY , USA
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Peuskens J, Pani L, Detraux J, De Hert M. The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review. CNS Drugs 2014; 28:421-53. [PMID: 24677189 PMCID: PMC4022988 DOI: 10.1007/s40263-014-0157-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since the 1970s, clinicians have increasingly become more familiar with hyperprolactinemia (HPRL) as a common adverse effect of antipsychotic medication, which remains the cornerstone of pharmacological treatment for patients with schizophrenia. Although treatment with second-generation antipsychotics (SGAs) as a group is, compared with use of the first-generation antipsychotics, associated with lower prolactin (PRL) plasma levels, the detailed effects on plasma PRL levels for each of these compounds in reports often remain incomplete or inaccurate. Moreover, at this moment, no review has been published about the effect of the newly approved antipsychotics asenapine, iloperidone and lurasidone on PRL levels. The objective of this review is to describe PRL physiology; PRL measurement; diagnosis, causes, consequences and mechanisms of HPRL; incidence figures of (new-onset) HPRL with SGAs and newly approved antipsychotics in adolescent and adult patients; and revisit lingering questions regarding this hormone. A literature search, using the MEDLINE database (1966-December 2013), was conducted to identify relevant publications to report on the state of the art of HPRL and to summarize the available evidence with respect to the propensity of the SGAs and the newly approved antipsychotics to elevate PRL levels. Our review shows that although HPRL usually is defined as a sustained level of PRL above the laboratory upper limit of normal, limit values show some degree of variability in clinical reports, making the interpretation and comparison of data across studies difficult. Moreover, many reports do not provide much or any data detailing the measurement of PRL. Although the highest rates of HPRL are consistently reported in association with amisulpride, risperidone and paliperidone, while aripiprazole and quetiapine have the most favorable profile with respect to this outcome, all SGAs can induce PRL elevations, especially at the beginning of treatment, and have the potential to cause new-onset HPRL. Considering the PRL-elevating propensity of the newly approved antipsychotics, evidence seems to indicate these agents have a PRL profile comparable to that of clozapine (asenapine and iloperidone), ziprasidone and olanzapine (lurasidone). PRL elevations with antipsychotic medication generally are dose dependant. However, antipsychotics having a high potential for PRL elevation (amisulpride, risperidone and paliperidone) can have a profound impact on PRL levels even at relatively low doses, while PRL levels with antipsychotics having a minimal effect on PRL, in most cases, can remain unchanged (quetiapine) or reduce (aripiprazole) over all dosages. Although tolerance and decreases in PRL values after long-term administration of PRL-elevating antipsychotics can occur, the elevations, in most cases, remain above the upper limit of normal. PRL profiles of antipsychotics in children and adolescents seem to be the same as in adults. The hyperprolactinemic effects of antipsychotic medication are mostly correlated with their affinity for dopamine D2 receptors at the level of the anterior pituitary lactotrophs (and probably other neurotransmitter mechanisms) and their blood-brain barrier penetrating capability. Even though antipsychotics are the most common cause of pharmacologically induced HPRL, recent research has shown that HPRL can be pre-existing in a substantial portion of antipsychotic-naïve patients with first-episode psychosis or at-risk mental state.
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Affiliation(s)
- J. Peuskens
- Department of Neurosciences, KU Leuven, University Psychiatric Centre, Catholic University Leuven, Kortenberg, Belgium
| | - L. Pani
- Italian Medicines Agency (AIFA), Rome, Italy
| | - J. Detraux
- Department of Neurosciences, KU Leuven, University Psychiatric Centre, Catholic University Leuven, Kortenberg, Belgium
| | - M. De Hert
- Department of Neurosciences, KU Leuven, University Psychiatric Centre, Catholic University Leuven, Kortenberg, Belgium
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