Differences in Prolactin Elevation and Related Symptoms of Atypical Antipsychotics in Schizophrenic Patients
J Clin Psychiatry 2005;66(6):761-767
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Objective: The aim of this cross-sectional study
was to investigate the degree and frequency of prolactin (PRL)
elevation and related symptoms in patients treated with 3
different atypical antipsychotics: clozapine, olanzapine, and
Method: Twenty-eight patients receiving
clozapine, 29 patients receiving olanzapine, and 18 patients
receiving risperidone (all meeting DSM-IV criteria for
schizophrenia, schizophreniform disorder, or schizoaffective
disorder) were studied. The median daily dose was 400 mg of
clozapine, 10 mg of olanzapine, and 3 mg of risperidone. Fasting
morning blood samples were analyzed for PRL, and the occurrence
of hyperprolactinemic symptoms in the patients was evaluated.
Results: Elevated PRL levels were found in 16
(89%) of the patients receiving risperidone and in 7 (24%) of the
patients receiving olanzapine, but in none of the patients
receiving clozapine. In addition, there was a significant
difference in median PRL level among the treatment groups
(p < .0001), in that the PRL level was higher both in the
patients treated with risperidone and in the patients treated
with olanzapine, compared to those treated with clozapine.
Moreover, hyperprolactinemic symptoms--menstrual disturbances,
galactorrhea, impotence, oligospermia, and decreased libido--were
reported in 8 (44%) of the risperidone-treated patients and in 1
(3%) of the olanzapine-treated patients, but in none of the
Conclusion: Treatment with risperidone was
frequently associated with hyperprolactinemia and related
symptoms, whereas the occurrence of PRL elevation and related
symptoms was modest in patients receiving olanzapine and
nonexistent in those receiving clozapine. Thus, atypical
antipsychotics in therapeutic doses differ with regard to effect
on PRL secretion.