East London Foundation NHS Trust, 9 Rush Court, Bedford, MK40 3JT, UK.
University College London, London, UK.
CNS Drugs. 2021 May;35(5):507-526. doi: 10.1007/s40263-021-00812-1. Epub 2021 Apr 20.
Psychotropic medication treatment can cause elevated serum prolactin levels and hyperprolactinaemia (HPRL). Reports have suggested that aripiprazole may decrease elevated prolactin. The aim of this review was to assess evidence for the efficacy of adjunct aripiprazole in the treatment of psychotropic-induced HPRL. PubMed and Google Scholar were searched to identify randomised placebo-controlled trials (RCTs) of adjunct aripiprazole in patients with HPRL attributed to primary psychotropic medications. Data for individual patients from case studies, chart reviews and open-label studies were also identified and assessed. Six RCTs, with a total of 609 patients, met inclusion criteria. Primary psychotropics included risperidone, haloperidol, paliperidone, fluphenazine and loxapine. Reductions in prolactin from baseline, before the introduction of aripiprazole, were significantly greater for adjunct aripiprazole than for adjunct placebo in all the studies (p = 0.04 to p < 0.0001). Normalisation of serum prolactin levels was significantly more likely with adjunct aripiprazole than adjunct placebo (p = 0.028 to p < 0.001, data from three studies). Improvement or resolution of HPRL-related symptoms (galactorrhoea, oligomenorrhoea, amenorrhoea and sexual dysfunction) were reported in three studies. Prolactin levels decreased in all case reports and in both of two open-label studies; they normalised in 30/41 patients (73.2%) in case studies and 12/29 (41.4%) in the open-label studies. Adjunct aripiprazole was statistically significantly effective in treating elevated serum prolactin levels in six RCTs. Evidence from case reports and open-label studies suggests a degree of effectiveness in most patients.
精神药物治疗会引起血清催乳素水平升高和高催乳素血症（HPRL）。有报道称，阿立哌唑可能会降低催乳素水平。本综述的目的是评估阿立哌唑辅助治疗精神药物引起的 HPRL 的疗效证据。通过检索 PubMed 和 Google Scholar，确定了评估 HPRL 患者使用阿立哌唑辅助治疗的随机安慰剂对照试验（RCT）。还确定并评估了病例研究、图表回顾和开放标签研究中个别患者的数据。符合纳入标准的有 6 项 RCT，共纳入 609 例患者。主要精神药物包括利培酮、氟哌啶醇、帕利哌酮、氟奋乃静和洛沙平。所有研究均显示，与安慰剂相比，阿立哌唑辅助治疗的催乳素从基线水平的降低更为显著（p=0.04 至 p<0.0001）。与安慰剂相比，阿立哌唑辅助治疗更有可能使血清催乳素水平正常化（p=0.028 至 p<0.001，来自 3 项研究的数据）。有 3 项研究报告了 HPRL 相关症状（溢乳、月经稀少、闭经和性功能障碍）的改善或缓解。所有病例报告和两项开放标签研究均显示催乳素水平下降；在病例研究中，30/41 例患者（73.2%）催乳素水平正常化，在开放标签研究中，12/29 例患者（41.4%）催乳素水平正常化。在 6 项 RCT 中，阿立哌唑辅助治疗可显著有效降低血清催乳素水平。病例报告和开放标签研究的证据表明，大多数患者均有一定的疗效。
