Evidence for the partial dopamine-receptor agonist aripiprazole as a first-line treatment of psychosis in patients with iatrogenic or tumorogenic hyperprolactinemia.
BACKGROUND
Antipsychotic drugs have many side effects, including elevation of prolactin levels through tuberoinfundibular dopamine-receptor blockade. Although a number of studies claim that aripiprazole is a prolactin-sparing antipsychotic drug that may even lower prolactin levels, there has not been an exhaustive evaluation of this claim.


OBJECTIVE
The authors analyzed the burgeoning literature suggesting that aripiprazole is efficacious in treating iatrogenic and tumorogenic hyperprolactinemia.


METHODS
The authors conducted a literature search for case studies, reports, and placebo-controlled trials that measured prolactin levels in adult patients taking aripiprazole.


RESULTS
The search identified 17 studies, in which 3,489 psychotic patients were given aripiprazole alone, as an adjuvant to haloperidol or risperidone, or to treat psychosis with a concomitant prolactinoma. Across all studies, aripiprazole lowered prolactin levels an average of 74.3%, even in psychotic patients with prolactinoma, whereas haloperidol and risperidone increased prolactin levels by as much as 272%.


CONCLUSIONS
These findings suggest that aripiprazole may play an important niche role in treating psychotic patients sensitive to elevated prolactin and patients with prolactin-secreting pituitary tumors.
Hoffer
Zachary S
ZS
correspondence and M.D., Friends Hospital, 4641 Roosevelt Boulevard, Philadelphia, PA 19124, USA.
Roth
Richard L
RL
Mathews
Maju
M
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D018492:Dopamine Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D006220:Haloperidol / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D006966:Hyperprolactinemia / Q000188:drug therapy* / Q000209:etiology; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D015363:Quinolones / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use
D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D010879:Piperazines; D015363:Quinolones; D000068180:Aripiprazole; D006220:Haloperidol; D018967:Risperidone