Hyperprolactinemia (Part 1/3): Antipsychotics

Q: Patient is a 30 year old female with history of schizophrenia presented with recent worsening of paranoid ideations and command auditory hallucinations. Patient have past history of symptomatic hyperprolactinaemia with antipsychotics trials. Which of the following antipsychotic medication can increases prolactin level (45 to >100 ng/ml) and should be avoided in this patient?

 


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Antipsychotics that Increases Prolactin (45 to >100 ng/ml) and
Should be AVOIDED in Patients with Breast Cancer:

  1. Risperidone
  2. Paliperidone
  3. Haloperidol

Antipsychotics that Increases Prolactin (20-50 ng/ml) and
Should be CAUTIONED in Patients with Breast Cancer:

  1. Olanzapine
  2. Iloperidone
  3. Lurasidone

Antipsychotics that Increases Minimal Prolactin and
Are PREFERRED in Patients with Breast Cancer:

  1. Ziprasidone
  2. Asenapine
  3. Quetiapine
  4. Clozapine

Antipsychotic that may Lower Prolactin and
is PREFERRED in Patients with Breast Cancer:

  1. Aripiprazole

For Typical Antipsychotics:

Phenothiazines (Chlorpromazine, Fluphenazine, Pipotiazine Trifluoperazine) and Butyrophenones (Haloperidol):

  • 2-3 fold increase occurs within hours of treatment initiation with further 2 fold elevation in the following weeks.

 

Thioxanthenes (Flupentixol, Zuclopenthixol):

  • Increase of prolactin 2-3 fold during the 1st month with reduction and normalisation after 6 months.

 


Source:

  1. Am J Psychiatry 2014;171:616-621.
  2. Journal of Psychopharmacology 22(2) Supplement (2008) 28–37
  3. The South London and Maudsley & Oxleas NHS Foundation Trusts Prescribing Guidelines, 11th edition. Wiley-Blackwell. 2012.
  4. Bazire S. Psychotropic Drug Directory. The Professionals’ Pocket Hand.
  5. Therapeutics and Clinical Risk Management 2007:3(5) 929–951.

Post by Dr. Harvinder Singh, M.D.

 

 


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