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Prolactin-Related and Metabolic Adverse Effects of Atypical Antipsychotic Agents

David C. Henderson, M.D., and P. Murali Doraiswamy, M.D.

While there are many effective antipsychotics available to clinicians for treating schizophrenia or bipolar mania, the onset of antipsychotic-associated prolactin-related and metabolic adverse effects can diminish the effectiveness of treatment. Increased levels of prolactin (hyperprolactinemia) associated with some antipsychotics raises the risk of sexual side effects. The increased appetite and/or sedation (reduced activity levels) induced by other antipsychotics can lead to weight gain, dyslipidemia, and high blood pressure and, if unchecked, ultimately to cardiovascular disease, diabetes, and metabolic syndrome. Clinicians should take steps to help their patients avoid unnecessary risks associated with antipsychotic use. These steps include monitoring risk factors for developing these illnesses by taking careful patient histories and baseline measurements of patients' weight and blood chemistry. Patients should be made aware of potential metabolic and prolactin-related side effects, and periodic checks should also be made to watch for changes in weight, body mass index, waist size, blood pressure, fasting glucose, or lipid levels that could be harmful and may increase risk for cardiovascular disease.

(J Clin Psychiatry 2008;69[suppl 1]:32-44)

From the Department of Psychiatry, Harvard Medical School, and the Schizophrenia, Diabetes, and Weight Reduction Research Program, Massachusetts General Hospital, Boston (Dr. Henderson); and the Division of Biological Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Dr. Doraiswamy).

This article is derived from the live satellite broadcast "Endocrine Adverse Effects of Atypical Antipsychotic Agents," which was held on June 5, 2007, and supported through an educational grant to i3 CME from Bristol-Myers Squibb and Otsuka America Pharmaceutical, Inc.

Dr. Henderson is a consultant for Wyeth, Solvay, Bristol-Myers Squibb, Janssen, and Otsuka and has received grant/research support from Eli Lilly, Pfizer, Solvay, and Bristol-Myers Squibb. Dr. Doraiswamy has, from time-to-time, received grant/research support from the National Institutes of Health, Pfizer, Eli Lilly, Organon, Wyeth, Janssen, Merck, Novartis, GlaxoSmithKline, and Forest; has served in the past as a consultant for Forest, Myriad, Bristol-Myers Squibb, Eli Lilly, Janssen, Forest, Pfizer, Wyeth, and Otsuka; and is a stock shareholder of Sonexa.

Corresponding author and reprints: David C. Henderson, M.D., 25 Staniford St., 2nd Floor, Boston, MA 02114 (e-mail: dchenderson@partners.org).