title: Elevated prolactin in pediatric patients on typical and atypical antipsychotics.
abstract: As part of systematic treatment trials of haloperidol, clozapine, and olanzapine with a total of 35 children and adolescents with early onset psychosis, prolactin was measured at baseline and week 6 of treatment. The National Institute of Mental Health patients--13 females, 22 males (mean age, 14.1+/-2.3 years; range, 9.1-19 years) with childhood onset schizophrenia (n = 32), or Psychotic Disorder not otherwise specified (NOS) (n = 3) with onset of psychosis before age 13--were recruited for open or double-blind trials of haloperidol, clozapine, or olanzapine. Baseline serum prolactin was measured after a 3-week washout period and after 6 weeks of treatment. Mean prolactin concentration after 6 weeks of treatment was significantly elevated on all three drugs; however, on clozapine, mean prolactin remained within the normal range. Prolactin was increased above the upper limit of normal for 100% of 10 patients on haloperidol, 70% of 10 patients on olanzapine, and 0% of 15 patients on clozapine (chi2 analyses: H > C, p = 0.004; O > C, p = 0.001). Given the potential endocrine and possible cardiac correlates of hyperprolactinemia, these more robust prolactin elevations in pediatric patients after short-term exposure to olanzapine than those reported for adults justify longer observation intervals with bigger samples to establish treatment safety of atypical antipsychotics in adolescents.
authors.affiliation: Child Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892-1600, USA. wudarsky@codon.nih.gov
authors.forename: M
authors.initials: M
authors.lastname: Wudarsky
authors.forename: R
authors.initials: R
authors.lastname: Nicolson
authors.forename: S D
authors.initials: SD
authors.lastname: Hamburger
authors.forename: L
authors.initials: L
authors.lastname: Spechler
authors.forename: P
authors.initials: P
authors.lastname: Gochman
authors.forename: J
authors.initials: J
authors.lastname: Bedwell
authors.forename: M C
authors.initials: MC
authors.lastname: Lenane
authors.forename: J L
authors.initials: JL
authors.lastname: Rapoport
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines; D002648:Child; D003024:Clozapine / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000009:adverse effects*; D006801:Humans; D008297:Male; D000077152:Olanzapine; D010890:Pirenzepine / Q000009:adverse effects / Q000031:analogs & derivatives*; D011388:Prolactin / Q000097:blood*; D012737:Sex Factors
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010890:Pirenzepine; D011388:Prolactin; D003024:Clozapine; D006220:Haloperidol; D000077152:Olanzapine