Prolactin levels in schizophrenia and schizoaffective disorder patients treated with clozapine, olanzapine, risperidone, or haloperidol.
BACKGROUND
Prolactin levels are elevated to varying degrees by antipsychotics. Prolactin elevations may result in sexual and other adverse effects, and they may be related to antipsychotic effects. We used the data collected in a trial of antipsychotics to study the differential effect of these drugs on prolactin level, to explore the relation between clinical effects and prolactin level, and to determine the relationship between plasma levels of antipsychotics and prolactin level.


METHODS
Treatment-resistant patients (133 men, 24 women) diagnosed with DSM-IV schizophrenia or schizoaffective disorder participated in a double-blind, randomized, 14-week trial comparing clozapine (N = 40), olanzapine (N = 39), risperidone (N = 41), and haloperidol (N = 37). Plasma levels of prolactin and antipsychotics were determined at baseline and at weeks 5, 8, 10, 12, and 14 during the trial. Clinical effects were measured with the Positive and Negative Syndrome Scale and the Extrapyramidal Symptom Rating Scale. Statistical analyses were limited to the 75 men for whom repeated prolactin levels were available. Data were gathered from June 1996 to December 1999.


RESULTS
Risperidone caused significant elevation of prolactin levels (p <.05) that appeared to be dose-dependent. Clozapine and olanzapine were associated with decreases of prolactin, whereas haloperidol led to a minor, nonsignificant increase. Plasma olanzapine and prolactin levels were correlated. Prolactin levels were not related to clinical improvement or extrapyramidal side effects.


CONCLUSIONS
Antipsychotics show major differences in their effects on prolactin, and risperidone has clearly the most robust effect.
Volavka
Jan
J
Nathan Kline Institute, Orangeburg, NY 10982, USA. Volavka@NKI.RFMH.ORG
Czobor
Pal
P
Cooper
Thomas B
TB
Sheitman
Brian
B
Lindenmayer
Jean-Pierre
JP
Citrome
Leslie
L
McEvoy
Joseph P
JP
Lieberman
Jeffrey A
JA
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D000077152:Olanzapine; D011388:Prolactin / Q000097:blood*; D018967:Risperidone / Q000009:adverse effects* / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy* / Q000503:physiopathology*; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D011388:Prolactin; D003024:Clozapine; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine