Aria Ghahramani1
Alfredo Bellon1,2*- 1Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, PA, United States
- 2Department of Pharmacology, Penn State Hershey Medical Center, Hershey, PA, United States
Despite the benefits of antipsychotic medications, there are known and severe side effects. The cardiometabolic side effects have been well-studied, and there are practice guidelines directing their management (1). In contrast, while most antipsychotics are known to increase prolactin levels, routine monitoring of serum prolactin has not yet been adopted as standard practice. The Clinical Guidelines of The Endocrine Society recommend monitoring of prolactin in symptomatic patients, and in certain pathologic states, however, they do not comment on how to proceed when patients are prescribed medications that are known to increase prolactin levels (2). Given the negative consequences of hyperprolactinemia (3), and the possibility for reasonable modifications to antipsychotic regimens (4, 5), we suggest routine monitoring of prolactin in patients who are prescribed antipsychotics.
The current standard in psychiatric practice is not to measure serum prolactin unless the patient becomes symptomatic, but hyperprolactinemia may be asymptomatic in the short term, and in the long term, there is potential for serious sequelae. In men and women, undetected hyperprolactinemia over time may cause decreased energy, reduced muscle mass, infertility, osteopenia, and bone fractures (6, 7).
Differences between prolactin effects among antipsychotics have been well-studied, with Amisulpride and Risperidone causing the greatest increase in serum prolactin, and Aripiprazole decreasing prolactin levels. The adverse effects are generally dose-dependent, and differential effects are thought to be mostly due to varying degrees of dopamine-2-receptor antagonism (8).
Given the serious side-effects of hyperprolactinemia and the possibilities for changing management by lowering dosage or switching to a different antipsychotic, we propose routinely monitoring prolactin levels in patients who are prescribed antipsychotics. A baseline prolactin level should be drawn prior to initiation of antipsychotics, and a follow-up level after titration is completed. While this may add to the cost of healthcare (9), we believe that the benefits to patients outweighs the financial burden. Just as we monitor cardiac and metabolic effects of antipsychotics, prolactin monitoring can help us provide more thoughtful and patient-centered treatment.
Author contributions
AG: Investigation, Writing – original draft. AB: Conceptualization, Supervision, Writing – review & editing.
Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Ling and Esther Tan Early Career Professorship endowment to AB.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
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6. Majumdar A, Mangal NS. Hyperprolactinemia. J Hum Reprod Sci (2013) 6(3):168–75. doi: 10.4103/0974-1208.121400
7. Luciano A. Clinical presentation of hyperprolactinemia. J Reprod Med (1999) 44(12 Suppl):1085–90.
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Keywords: antipsychotics, prolactin, schizophrenia, bipolar disorder, depression, osteopoenia/osteoporosis, sexual dysfuntion, endocrinology
Citation: Ghahramani A and Bellon A (2024) Monitoring prolactin in patients taking antipsychotics. Front. Psychiatry 15:1333280. doi: 10.3389/fpsyt.2024.1333280
Received: 04 November 2023; Accepted: 16 January 2024;
Published: 30 January 2024.
Edited by:
Gretchen L. Haas, University of Pittsburgh, United StatesReviewed by:
Axel Steiger, Ludwig Maximilian University of Munich, GermanyMassimo Tusconi, University of Cagliari, Italy
Melanie Föcking, Royal College of Surgeons in Ireland, Ireland
Copyright © 2024 Ghahramani and Bellon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alfredo Bellon, abellon@pennstatehealth.psu.edu