Causas y manejo de la hiperprolactinemia por antipsicóticos

Pharmacological treatments for chronic psychiatric illness can induce changes in prolactin (PRL) serum, including drugs that are used for the treatment of bipolar disorder. This effect has clinically relevant consequences for patients, such as sexual dysfunction, osteoporosis or tumors sensitive to PRL. An increase in PRL serum level is a common effect of treatment with antipsychotics, and until recently, the differences between various compounds of this class of drugs were not evaluated. Typical antipsychotics cause a significant increase in PRL serum compared with atypical antipsychotics (amisulpride, risperidone and paliperidone). Asenapine, olanzapine and ziprasidone have a slight effect on PRL levels. Lurasidone and quetiapine did not appear to cause an increase in PRL, whereas aripiprazole, even at high doses, causes PRL to decrease. In the clinical management of antipsychotic-induced hyperprolactinemia, one can assess the value of switching to a drug with less of an impact on PRL, or an integrated treatment with one that has no effect on or decreases PRL serum levels, for example with lithium, while taking into account the balance between effectiveness and tolerability and the patient's profile and needs.