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Antipsychotic-induced hyperprolactinaemia in women: pathophysiology, severity and consequences

Selective literature review

Manchester Mental Health and Social Care Trust, Manchester

P. M. HADDAD, MRCPsych

Mental Health Services of Salford, Salford, UK

Correspondence: Dr A. Wieck, Manchester Mental Health and Social Care Trust, Laureate House, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK. E-mail: angelika.wieck{at}man.ac.uk

Declaration of interest Both authors have received research grants, lecture fees and conference expenses from the manufacturers of several atypical antipsychotic drugs.

Background Hyperprolactinaemia has for decades been an inevitable and neglected side-effect of antipsychotic medication. The recent introduction of prolactin-sparing antipsychotic agents makes a re-examination of this problem timely.

Aims To review the literature on antipsychotic-induced hyperprolactinaemia and its consequences.

Method A search was made of the Medline database (1966-2002) for key articles, supplemented by cross-referencing.

Results During antipsychotic treatment prolactin concentrations can rise to ten times normal levels or above, and existing data indicate that 17-78% of female patients have amenorrhoea with or without galactorrhoea. Survey data, however, suggest that clinicians underestimate the prevalence of these conditions. Long-term consequences of antipsychotic-related hypo-oestrogenism require further research but are likely to include premature bone loss.

Conclusions Antipsychotic-induced hyperprolactinaemia should become a focus of interest in the drug treatment of psychiatric patients.

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