Age- and sex-dependency of psychotropic drug induced hyperprolactinemia

Abstract

Introduction: Antipsychotics which are inhibitors of dopamine D2-receptors but also antidepressant dugs with serotoninergic activity can cause hyperprolactinemia. The most frequent symptoms of chronic hyperprolactinemia include reproductive dysfunction (anovulation, menstrual irregularity, sub-fertility, decreased estrogen and testosterone production), sexual impairment, galactorrhea, breast enlargement, disorders associated with chronic hypogonadism (decreased bone mineral density and osteoporosis, increased cardiovascular risk) and possibly an increased malignity of breast cancer. The aim of this study was to further elaborate age-, sex- and drug-dependency of psychotropic drug-induced hyperprolactinemia. Methods: Data from 210 patients whose prolactin values were estimated in the last four years and of cases collected by the spontaneous ADR reporting system AGATE (Arbeitsgemeinschaft Arzneimitteltherapie bei psychiatrischen Erkrankungen) were analysed retrospectively. Results: 66% percent of all cases with hyperprolactinemia and associated symptoms reported to AGATE occurred in women who were younger than 45 years. In the group of 18–45 year-old patients with hyperprolactinemia, 70% of the women but only 40% of the men reported hyperprolactinemia-associated symptoms. Compared to postmenopausal women and men, premenopausal women had significantly higher values of prolactin. Hyperprolactinemia and associated symptoms (n=65) were most frequently reported for patients under therapy with risperidone/paliperidone (n=27) and amisulpride (n=16). The remaining cases were associated with olanzapine (n=6), classical antipsychotics (n=6), SSRI/SSNRI (n=2) or combinations of these drugs. Conclusions: Premenopausal women have the highest risk of symptomatic hyperprolactinemia. It is therefore recommendable to monitor prolactin values and hyperprolactinemia associated symptoms especially in this group of patients.