Lu Mong-Liang, Shen Winston W, Chen Chun-Hsin
Department of Psychiatry, School of Medicine, Taipei Medical University, and Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
Prog Neuropsychopharmacol Biol Psychiatry. 2008 Dec 12;32(8):1978-81. doi: 10.1016/j.pnpbp.2008.09.016. Epub 2008 Sep 30.
Hyperprolactinemia is an important but neglected adverse effect of antipsychotic medication. All first generation antipsychotics and the second generation antipsychotics amisulpride and risperidone have been shown to cause marked elevation in serum prolactin levels, whereas most other second generation antipsychotics and aripiprazole appear to have little or no effect on serum prolactin levels. This study was aimed to assess the time course of changes in antipsychotic-induced hyperprolactinemia during the process of antipsychotic switching to aripiprazole. Twenty-three female schizophrenic subjects with risperidone- or sulpiride-induced symptomatic hyperprolactinemia were recruited into the study and 20 of them completed the trial. We added aripiprazole to the therapeutic dose first, then overlapped the preexisting antipsychotic treatment and aripiprazole, and finally tapered the preexisting antipsychotic treatment. Clinical status was assessed by using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Severity Scale (CGI-S). Assessment scales and serum prolactin levels were measured at baseline, during the combination treatment period, and four weeks after having completed discontinuation of the preexisting antipsychotic treatment. Switching antipsychotic drugs to aripiprazole was effective in reducing serum prolactin levels and restoring menstruation in schizophrenic patients who received prolactin-raising antipsychotics. Mean serum prolactin levels at baseline, during combination period, and after the switch were 97.0+/-69.0 ng/ml, 27.2+/-10.6 ng/ml (p<0.001, vs. baseline), and 12.2+/-5.3 ng/ml (p<0.001, vs. baseline), respectively. None of the study subjects experienced any serious adverse effects during the switching process. No significant changes were noted in the PANSS and CGI-S scores during the switching process. The prolactin-normalizing effects of aripiprazole are likely caused by the unique characteristics of the dopamine partial agonist with its high affinity for dopamine D2 receptors.
高催乳素血症是抗精神病药物一种重要但被忽视的不良反应。所有第一代抗精神病药物以及第二代抗精神病药物氨磺必利和利培酮均已被证明可导致血清催乳素水平显著升高，而大多数其他第二代抗精神病药物及阿立哌唑似乎对血清催乳素水平几乎没有影响或没有影响。本研究旨在评估在抗精神病药物换用阿立哌唑过程中抗精神病药物所致高催乳素血症的变化时间进程。23名患有利培酮或舒必利所致症状性高催乳素血症的女性精神分裂症患者被纳入本研究，其中20名完成了试验。我们首先将阿立哌唑添加至治疗剂量，然后使原有的抗精神病药物治疗与阿立哌唑重叠，最后逐渐减少原有的抗精神病药物治疗。通过使用阳性和阴性症状量表（PANSS）和临床总体印象严重程度量表（CGI-S）评估临床状态。在基线、联合治疗期间以及完成停用原有抗精神病药物治疗四周后测量评估量表和血清催乳素水平。将抗精神病药物换用阿立哌唑可有效降低接受升高催乳素的抗精神病药物治疗的精神分裂症患者的血清催乳素水平并恢复月经。基线、联合治疗期间及换药后的平均血清催乳素水平分别为97.0±69.0 ng/ml、27.2±10.6 ng/ml（与基线相比，p<0.001）和12.2±5.3 ng/ml（与基线相比，p<0.001）。在换药过程中，没有研究对象出现任何严重不良反应。在换药过程中，PANSS和CGI-S评分没有显著变化。阿立哌唑使催乳素恢复正常的作用可能是由多巴胺部分激动剂对多巴胺D2受体具有高亲和力的独特特性所致。
