Antipsychotic-induced hyperprolactinaemia in women: pathophysiology, severity and consequences

BACKGROUND: Hyperprolactinaemia has for decades been an inevitable and neglected side-effect of antipsychotic medication. The recent introduction of prolactin-sparing antipsychotic agents makes a re-examination of this problem timely. AIMS: To review the literature on antipsychotic-induced hyperprolactinaemia and its consequences. METHOD: A search was made of the Medline database (1966-2002) for key articles, supplemented by cross-referencing. RESULTS: During antipsychotic treatment prolactin concentrations can rise to ten times normal levels or above, and existing data indicate that 17-78% of female patients have amenorrhoea with or without galactorrhoea. Survey data, however, suggest that clinicians underestimate the prevalence of these conditions. Long-term consequences of antipsychotic-related hypo-oestrogenism require further research but are likely to include premature bone loss. CONCLUSIONS: Antipsychotic-induced hyperprolactinaemia should become a focus of interest in the drug treatment of psychiatric patients.