Aikaterini Kalogeropoulou

Anastasia Roussi

B-H Lee

Christina Leotsakou

Georgios Vagionis

J-C Shim

M Paulzen

Markella Fiste

Paraskevi Kotorki

Parthena Pelka

Periklis Paterakis

Annals of General Psychiatry

English

PubMed

Springer - Publisher Connector

Reversal of symptomatic antipsychotic-induced hyperprolactinemia with addition of aripiprazole

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MEETING ABSTRACT Open Access
Reversal of symptomatic antipsychotic-induced
hyperprolactinemia with addition of aripiprazole
Paraskevi Kotorki2*, Parthena Pelka1, Christina Leotsakou1, Aikaterini Kalogeropoulou1, Markella Fiste1,
Georgios Vagionis3, Anastasia Roussi1, Periklis Paterakis1
From 1st International Congress on Neurobiology and Clinical Psychopharmacology and European
Psychiatric Association Conference on Treatment Guidance
Thessaloniki, Greece. 19-22 November 2009
Background
Hyperprolactinemia is a well-recognized adverse effect
of treatment with antipsychotic medication. From the
second generation antipsychotics amisulpride, risperi-
done and paliperidone cause marked elevation in serum
prolactin levels. Aripiprazole lowers serum prolactin
below placebo when used as a single agent and as an
adjunctive treatment has been shown, though not con-
sistently, to improve antipsychotic-induced hyperprolac-
tinemia. It may bind to the dopamine receptor more
robustly and act as a dopamine receptor agonist in an
antipsychotic-induced hypodopaminergic state. We
report two cases of successful treatment of risperidone-
and amisulpride-induced hyperprolactinemia and ame-
norrhea by addition of aripiprazole. This strategy was
chosen over administration of an adjunctive dopamine
agonist or discontinuation of treatment and a switch to
a different antipsychotic agent to avoid clinical
deterioration.
Materials and methods
Case 1
Ms M, a 35-year-old woman, had an eight-year history
of DSM-IV paranoid schizophrenia with one previous
compulsory admission. She was involuntarily admitted
to our hospital for her third and very severe episode.
She was successfully treated on our ward with 800 mg
of amisulpride, which was the second trial of antipsy-
chotic. She was discharged after almost 3 months.
Amisulpride was gradually reduced to 400 mg after
6 months of treatment. The patient had developed ame-
norrhea which continued even after lowering the dose
of amisulpride, something consistent with the existing
data. It was the patient’s decision not to discontinue
amisulpride as it was very effective for her psychiatric
symptoms, especially for her positive symptoms. She
had gained insight and was scared about “voices and
peculiar ideas coming back”. Gradually, 10 mg of aripi-
prazole were added, and after 12 weeks she regained
menstruation and prolactin levels fell (from 81 ng/ml
under amisulpride to 28 ng/ml). The patient remained
clinically stable.
Case 2
Ms E, a 30-year-old woman, had a four-year history of
DSM-IV paranoid schizophrenia with no previous
admission. She was involuntarily admitted to hospital
for her third episode and was effectively treated with ris-
peridone 6 mg. Risperidone was reduced to 4.5 mg two
months after discharge. The patient had developed ame-
norrhea which continued 6 months after lowering the
dose of risperidone. Aripiprazole 10 mg was gradually
added. After 13 weeks she regained menstruation and
prolactin levels fell (from 95 ng/ml under risperidone to
25 ng/ml 65%). The patient remained clinically stable.
Results
Both subjects were clinically stable and there was a high
potential risk for relapse due to their history. This led
us to the addition of aripiprazole which successfully
improved hyperprolactinemia. Treatment was safe and
well-tolerated. Both patients regained their menstrual
periods in more than 8 weeks, a time period that was
previously reported. It appears that aripiprazole is effec-
tive in normalizing prolactin in some patients and this
could become a treatment of choice.
21st and 5th Department, Dromokaition Psychiatric Hospital, Athens, Greece
Kotorki et al. Annals of General Psychiatry 2010, 9(Suppl 1):S164
http://www.annals-general-psychiatry.com/content/9/S1/S164
© 2009 Kotorki et al.; licensee BioMed Central Ltd.
Conclusions
When aripiprazole is co-administed with risperidone or
sulpiride, it may bind to the dopamine receptor more
robustly and act as a dopamine receptor agonist in an
antipsychotic-induced hypodopaminergic state. It
appears that aripiprazole is effective in normalizing (or
partially normalizing) prolactin in some patients and
reversing the clinical side effects without serious side
effects or sacrificing psychopathology, and this could
become a treatment of choice. Contrary to these find-
ings, Paulzen and Gründer reported a lack of an
expected decrease of serum prolactin levels by adding
aripiprazole in patients treated with amisulpride. A pos-
sibility of partial, but not total restoration of sympto-
matic hyperprolactinemia might be due to the relatively
low aripiprazole dose (10mg/day). Receiving aripiprazole
15-20 mg/day with risperidone has been reported to
successfully reverse risperidone-induced hyperprolacti-
nemia. The association between aripiprazole dose and
prolactin level when used as adjunctive treatment needs
to be more fully evaluated.
Author details
1Social Insurance Institute, Analipsi, Thessaloniki, Greece. 21st and 5th
Department, Dromokaition Psychiatric Hospital, Athens, Greece. 3Psychiatric
Clinic, General Hospital of Chania, Greece.
Published: 22 April 2010
References
1. Lee B-H, Kim Y-K, Park S-H: Using aripiprazole to resolve antipsychotic-
induced symptomatic hyperprolactinemia: a pilot study. Progress in
Neuro-Psychopharmacology & Biological Psychiatry 2006, 30:714-7.
2. Paulzen M, Gründer G: Amisulpride-induced hyperprolactinemia is not
reversed by addition of aripiprazole. Int J Neuropsychopharmacol 2007,
10:149-51.
3. Shim J-C, Shin KJ-G, Kelly DL, Jung D-U, Seo Y-S, Shon J-H, Conley R:
Adjunctive treatment with a dopamine partial agonist, aripiprazole, for
antipsychotic-induced hyperprolactinemia: a placebo-controlled trial. Am
J Psychiatry 2007, 164(9):1404-1410.
doi:10.1186/1744-859X-9-S1-S164
Cite this article as: Kotorki et al.: Reversal of symptomatic antipsychotic-
induced hyperprolactinemia with addition of aripiprazole. Annals of
General Psychiatry 2010 9(Suppl 1):S164.
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Kotorki et al. Annals of General Psychiatry 2010, 9(Suppl 1):S164
http://www.annals-general-psychiatry.com/content/9/S1/S164
Page 2 of 2


Adjunctive treatment with a dopamine partial agonist, aripiprazole, for antipsychotic-induced hyperprolactinemia: a placebo-controlled trial.

Amisulpride-induced hyperprolactinemia is not reversed by addition of aripiprazole.

S-H: Using aripiprazole to resolve antipsychoticinduced symptomatic hyperprolactinemia: a pilot study.

Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance

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Reversal of symptomatic antipsychotic-induced hyperprolactinemia with addition of aripiprazole

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