Hyperprolactinemia and medications for bipolar disorder: Systematic review of a neglected issue in clinical practice

Based on the results of this review, lithium and valproate appear to be safer due to their low potential to elevate serum prolactin (sPrL); among antipsychotics, quetiapine, lurasidone and aripiprazole appear to be similarly safe.


Drug-induced changes in serum prolactin (sPrl) levels constitute a relevant issue due to the potentially severe consequences on physical health of psychiatric patients such as sexual dysfunctions, osteoporosis and Prl-sensitive tumors. Several drugs have been associated to sPrl changes. Only antipsychotics have been extensively studied as sPrl-elevating agents in schizophrenia, but the extent to which bipolar disorder (BD) treatments affect sPrl levels is much less known. The objective of this systematic review is to summarize the evidence of the effects of drugs used in BD on Prl. This review followed the PRISMA statement. The MEDLINE/PubMed/Index Medicus, EMBASE, and Cochrane Library databases were systematically searched for articles in English appearing from any time to May 30, 2014. Twenty-six studies were included. These suggest that treatments for BD are less likely to be associated with Prl elevations, with valproate, quetiapine, lurasidone, mirtazapine, and bupropion reported not to change PRL levels significantly and lithium and aripiprazole to lower them in some studies. Taking into account the effects of the different classes of drugs on Prl may improve the care of BD patients requiring long-term pharmacotherapy.


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good one…

Thanks for posting…

US Brand names: Seroquel, Latuda and Abilify. Abilify was approved today by the FDA to be produced generically, btw. All of these are terrific meds known to work at lower dosage levels producing less intense sfx.

Hyperprolactinaemia or hyperprolactinemia (HP) is the presence of abnormally high levels of prolactin in the blood. Normal levels are less than 500 mIU/L [20 ng/mL or µg/L] for women, and less than 450 mIU/L for men.

From Wikpedia entry.

which suggests upper normal level for men is 375 mIU/L .

I have heard 330 bandied about in my depot clinic which goes to show variation in the so called ’ normal range’.

My levels have ranged from 625-725.

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Which anti-P have you been taking and for how long?

Yeah; I have seen levels like those in pts who used Risperdal risperidone for years. See below from http://www.aafp.org/afp/2010/0301/p617.html#sec-5, though it’s about ten years old now.

"Antipsychotics cause high prolactin levels by blocking the normal tonic inhibition on pituitary mammotropic cells of dopamine produced in the hypothalamus. Hyperprolactinemia is common with the use of any FGA, as well as with the SGA risperidone (up to 60 percent of women and 40 percent of men),19 and is dose dependent. It appears to be much less common with other SGAs, but has been reported with the use of olanzapine (Zyprexa) and ziprasidone (Geodon) at high dosages.6

"Hyperprolactinemia can be asymptomatic, but may cause gynecomastia, galactorrhea, oligo- or amenorrhea, sexual dysfunction, acne, hirsutism, infertility, and loss of bone mineral density. Symptoms often appear within a few weeks of beginning the antipsychotic or increasing the dosage, but can also arise after long-term stable use.

“There is growing evidence that chronic hyperprolactinemia from antipsychotics can cause osteoporosis and an increased risk of hip fracture. A recent case-control analysis of a large general practice database in the United Kingdom showed that the risk of hip fracture was 2.6 times higher in patients taking prolactin-raising antipsychotics compared with the general population.20 Physicians should routinely inquire about symptoms that might reflect hyperprolactinemia in patients taking prolactin-raising antipsychotics and, if present, measure the serum prolactin level. Presence of osteoporosis, sexual side effects, or prolactin-dependent breast cancer may necessitate switching to an antipsychotic that does not raise prolactin levels, such as aripiprazole (Abilify) or quetiapine (Seroquel).21”

I’ve been on risperdal consta 25mgs since May 2009. A test for osteoprosis a couple of years ago was clear. My libido is rather low (possibly testosterone levels are down).