Amisulpride – induced hyperprolactinemia - Case report

Abstract

Background: One of the most discussed adverse effect of antipsychotics is hyperprolactinemia. Dopamine antagonists block the D2 receptors of the lactotroph cells and prevent inhibition of prolactin secretion which determines increased levels of prolactin. Typical antipsychotics can increase the prolactin level up to 10 times the normal values, haloperidol and chlorpromazine producing a higher increase than olanzapine, prolactin increasing during the first week of treatment and returning to normal after 2-3 weeks. Atypical antipsychotics determine lower increasing in prolactin compared to first generation, but amisulpride and risperidone have been associated with higher levels of prolactin. Material and methods: We present the case of a 29 years old woman who developed hyperprolactinemia under treatment with Amisulpride, although the clinical evolution was improved. Case particularities: One of the particularities of this case was the high level of prolactin induced by treatment with Amisulpride, another particularity being the fact that patient's work and social functionality was not impaired, even if the auditory hallucinations persisted. Conclusions; Antipsychotic-induced hyperprolactinemia should become a focus of interest in the drug treatment of psychiatric patients. Endocrine symptoms occur in a large proportion of women treated with prolactin-elevating antipsychotic drugs. These symptoms can cause significant distress and may affect compliance with medication. The presence of menstrual irregularities, breast symptoms and sexual dysfunction should be assessed before and during treatment with prolactin-elevating drugs and management options should be discussed with the patient.