title: Psychotropic-induced hyperprolactinemia: a clinical review.
abstract: BACKGROUND
  Psychotropic medications, particularly select antipsychotics, are a common cause of drug-induced hyperprolactinemia. As high prolactin may be associated with hypogonadism, reproductive dysfunction, and bone loss, it is important to recognize this condition and understand its management.
  
  
  OBJECTIVE
  The aim of this review is to evaluate the causes, signs, and symptoms associated with hyperprolactinemia, to describe mechanisms through which psychotropic medications elevate prolactin, and to suggest an evidence-based management approach for patients with psychotropic drug-induced hyperprolactinemia.
  
  
  METHODS
  A PubMed/MEDLINE search was conducted on the topic of psychotropic agents as a cause of hyperprolactinemia. The material with most relevance to current psychiatric practice and of highest level of evidence was included in this review.
  
  
  CONCLUSIONS
  Hyperprolactinemia should be evaluated in adult patients receiving psychotropic agents if signs and symptoms associated with hyperprolactinemia are present. It is also important to exclude pituitary and hypothalamic disease by magnetic resonance imaging if hyperprolactinemia is not definitely caused by psychotropic medications. As bone loss may occur because of hyperprolactinemia-mediated hypogonadism, bone mineral density (BMD) should be evaluated in patients with persistent high prolactin and reproductive dysfunction. Aripiprazole or other prolactin-sparing atypical antipsychotics may be alternatives or aripiprazole can be considered as adjunctive therapy in select cases of psychotropic-induced hyperprolactinemia.
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Ajmal
authors.affiliation: Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: lnachtigall@partners.org.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Nachtigall
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006966:Hyperprolactinemia / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D008297:Male
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents