Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki 036-8562, Japan.
Prog Neuropsychopharmacol Biol Psychiatry. 2010 Apr 16;34(3):537-40. doi: 10.1016/j.pnpbp.2010.02.014. Epub 2010 Feb 17.
Hyperprolactinemia is a frequent consequence of treatment with antipsychotic agents, partially because the prolactin response to antipsychotics is related to dopamine blockade. Recent studies have suggested that the prolactin response to olanzapine is weaker than that to risperidone. Thus, we studied the effects of various factors on the elevated plasma prolactin levels caused by these medications. The subjects were 94 patients with acutely exacerbated schizophrenia (46 males, 48 females). For four weeks, they received 6mg of risperidone and 20mg of olanzapine daily. Plasma samples were collected before the medications were given and 12h after the bedtime dosing each week. Treatment with either risperidone or olanzapine boosted plasma prolactin levels above baseline in both males and females. Prolactin levels were significantly higher in females than in males at all sampling points in both treatments. Risperidone increased prolactin significantly more than did olanzapine in both males and females. Delta prolactin (prolactin level at four weeks minus the baseline prolactin level) during olanzapine treatment significantly correlated with olanzapine concentration at 4th week (r=-0.518, p<0.01) only in males. Multiple regression analyses showed that delta prolactin during risperidone was significantly correlated with gender (p<0.001) and age (p<0.05) and that delta prolactin during olanzapine significantly correlated with gender (p<0.001) and drug concentration (p<0.01). The present study suggests that the predominant factors influencing hyperprolactinemia are young female for risperidone treatment, and being female and lower drug concentration as a predictor for hyperprolactinemia under olanzapine.
高催乳素血症是抗精神病药物治疗的常见后果，部分原因是抗精神病药物引起的催乳素反应与多巴胺阻断有关。最近的研究表明，奥氮平引起的催乳素反应弱于利培酮。因此，我们研究了各种因素对这些药物引起的血浆催乳素水平升高的影响。受试者为 94 例急性加重的精神分裂症患者（男 46 例，女 48 例）。四周内，他们每天分别接受 6mg 利培酮和 20mg 奥氮平治疗。在给予药物之前和每周睡前给药后 12h 采集血浆样本。利培酮和奥氮平治疗均使男性和女性的血浆催乳素水平高于基线。在两种治疗中，女性的催乳素水平在所有采样点均明显高于男性。利培酮和奥氮平均使男性和女性的催乳素水平显著升高，而利培酮升高的程度明显高于奥氮平。奥氮平治疗期间的 delta 催乳素（四周时的催乳素水平减去基线催乳素水平）与第四周时的奥氮平浓度呈显著负相关（r=-0.518，p<0.01），仅在男性中如此。多元回归分析显示，利培酮治疗期间的 delta 催乳素与性别（p<0.001）和年龄（p<0.05）显著相关，奥氮平治疗期间的 delta 催乳素与性别（p<0.001）和药物浓度（p<0.01）显著相关。本研究表明，催乳素升高的主要影响因素为利培酮治疗时的年轻女性，以及奥氮平治疗时的女性和较低的药物浓度。
