The Sexual Side-Effects of Antipsychotics

continued from

Management of Hyperprolactinaemia

Before initiating antipsychotic treatment, a careful examination of the patient is necessary. In routine situations, clinicians should examine patients for evidence of sexual adverse events, including menorrhagia, amenorrhoea, galactorrhoea and erectile/ejaculatory dysfunction. If evidence of any such effects are found, then the patient's prolactin level should be measured. This is an important prerequisite to differentiate between adverse effects due to the current medication, those remaining from the previous medication or symptoms of the illness. Furthermore, such checks should be repeated at regular intervals.

The current recommendation is that a rise in prolactin concentrations should not be of concern unless complications develop, and until such time no change in treatment is required. Increased prolactin may be due to the formation of macroprolactin, which does not have serious consequences for the patient. If there are doubts that hyperprolactineamia is related to antipsychotic treatment, other possible causes of the hyperprolactinaemia have to be excluded; these include pregnancy, nursing, stress, tumours and other drug therapies.

When treating antipsychotic-induced hyperpro-lactinaemia, decisions should be made on an individual basis after a full and frank discussion with the patient. These discussions should include consideration of the benefits of antipsychotic therapy, as well as the potential impact of any adverse effects. The importance of discussing symptom impact is highlighted by data showing that only a minority of patients discontinue their antipsychotic medication because of breast tenderness, galactorrhoea or menstrual irregularities. However, sexual side-effects are thought to be one of the most important causes for non-compliance. Therefore, the decision whether the current treatment with a prolactin-increasing antipsychotic should be continued or switched to an antipsychotic drug not characteristically associated with increases in prolactin levels has to be made on the basis of the patient's risk-benefit estimation.

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Adjunctive therapies have also been tested to reduce the symptoms of hyperprolactinaemia, but these are associated with their own risks. Oestrogen replacement can prevent the effects of oestrogen deficiency but it carries the risk of thromboembolism. Dopamine agonists such as carmixirole, cabergoline and bromocriptine have been suggested for the management of hyperprolactinaemia in patients receiving antipsychotics, but these are associated with side-effects and may worsen psychosis.

Source: Hyperprolactinaemia and Antipsychotic Therapy in Schizophrenia, Martina Hummer and Johannes Huber. Curr Med Res Opin 20(2):189-197, 2004.

Last updated: 10/05

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