Kinon Bruce J, Gilmore Julie A, Liu Hong, Halbreich Uriel M
Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana 46285, USA.
Psychoneuroendocrinology. 2003 Apr;28 Suppl 2:69-82. doi: 10.1016/s0306-4530(02)00128-2.
Atypical antipsychotic drugs for the treatment of schizophrenia provide effective treatment of psychotic symptoms with a safety profile superior to conventional antipsychotic medications. Neuroendocrine abnormalities in patients with schizophrenia, such as chronic hyperprolactinemia, may now potentially be minimized by the use of newer prolactin-sparing antipsychotic drugs. A discrimination of prolactin-sparing versus prolactin-elevating antipsychotic drugs may provide the clinician with treatment choices in order to avoid or mitigate hyperprolactinemia-associated morbidity.
Results from five clinical trials were used to characterize factors that may influence antipsychotic drug effects on levels of serum prolactin. Factors investigated included drug treatment, gender, time course, potential for reduction or reversibility, and age.
Factors that influenced the risk of hyperprolactinemia included gender, with females appearing to be more sensitive than males, and drug treatment, with risperidone and conventional antipsychotic agents increasing prolactin more than olanzapine. Patients of all ages demonstrated sensitivity to increased prolactin. Furthermore, patients with hyperprolactinemia sustained the effect over time. Hyperprolactinemia reversed when patients were switched to a prolactin-sparing antipsychotic medication.
Effects of antipsychotic medications on serum prolactin are multi-factorial. Evidence for sexual, reproductive, and general medical consequences of antipsychotic-induced hyperprolactinemia is developing, and identifying antipsychotic drugs with a favorable prolactin profile would be important in mitigating these consequences. Most notably for women, atypical or novel antipsychotic drugs with a prolactin-sparing profile may offer effective clinical treatment with preservation of physiological hormonal function.
用于治疗精神分裂症的非典型抗精神病药物能有效治疗精神病症状，其安全性优于传统抗精神病药物。精神分裂症患者的神经内分泌异常，如慢性高催乳素血症，现在可能通过使用更新的、不升高催乳素的抗精神病药物而得到潜在的最小化。区分不升高催乳素与升高催乳素的抗精神病药物可为临床医生提供治疗选择，以避免或减轻与高催乳素血症相关的发病率。
五项临床试验的结果用于确定可能影响抗精神病药物对血清催乳素水平作用的因素。所研究的因素包括药物治疗、性别、时间进程、降低或可逆的可能性以及年龄。
影响高催乳素血症风险的因素包括性别，女性似乎比男性更敏感；以及药物治疗，利培酮和传统抗精神病药物比奥氮平更易升高催乳素。所有年龄段的患者对催乳素升高均表现出敏感性。此外，高催乳素血症患者随着时间的推移持续存在这种影响。当患者改用不升高催乳素的抗精神病药物时，高催乳素血症会逆转。
抗精神病药物对血清催乳素的影响是多因素的。抗精神病药物所致高催乳素血症的性、生殖和一般医学后果的证据正在形成，识别具有良好催乳素特征的抗精神病药物对于减轻这些后果很重要。最值得注意的是对女性而言，具有不升高催乳素特征的非典型或新型抗精神病药物可能在保留生理激素功能的同时提供有效的临床治疗。
