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The Annals of Pharmacotherapy: Vol. 37, No. 2, pp. 206-208. DOI 10.1345/aph.1C210
© 2003 Harvey Whitney Books Company.
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Resolution of Risperidone-Induced Hyperprolactinemia with Substitution of Quetiapine

Arun Raj Kunwar, MD

Resident, Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY

James L Megna, MD PhD

Assistant Professor, Department of Psychiatry; Clinical Assistant Professor, Department of Internal Medicine, SUNY Upstate Medical University; Member, Pfizer Speakers Bureau

Reprints: James L Megna MD PhD, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210-1834, FAX 315/464-9101, E-mail megnaj{at}upstate.edu

OBJECTIVE: To report a case of risperidone-induced hyperprolactinemia that was successfully managed with quetiapine.

CASE SUMMARY: A 30-year-old white woman with schizoaffective disorder, depressive type, and comorbid alcohol and cocaine abuse was treated successfully for her psychotic symptoms with risperidone until she developed adverse effects consistent with hyperprolactinemia. This was confirmed by laboratory blood tests, as her prolactin level was 186.9 ng/mL (normal for nonpregnant women 2.8–29.2). The woman had experienced similar effects in the past, which had led to noncompliance and subsequent psychotic relapse. Normalization of prolactin levels and associated adverse effects were achieved upon switching to quetiapine. No psychotic symptoms reoccurred.

DISCUSSION: Dopamine type 2 (D2) receptor blockade in the mesolimbic tract is thought to mediate the therapeutic effects of antipsychotics. This action in the tuberoinfundibular system produces prolactin level elevation. Risperidone has a relatively higher affinity for the D2 receptor in comparison with other atypical antipsychotics, which may explain why it is associated with a higher incidence of hyperprolactinemia. Quetiapine, which has one of the lowest D2 receptor affinities, is not known to increase prolactin levels to any significant degree. This pharmacologic property allows quetiapine to be a reasonable treatment option for patients who develop risperidone-induced hyperprolactinemia.

CONCLUSIONS: Quetiapine may be a suitable substitute when a patient taking risperidone develops hyperprolactinemia.

Key Words: hyperprolactinemia, quetiapine, risperidone

Published Online, December 30, 2002. www.theannals.com, DOI


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Switching Elderly Patients With Dementia From Risperidone to Quetiapine: A Retrospective Study
American Journal of Alzheimer's Disease and Other Dementias, May 1, 2006; 21(3): 169 - 174.
[Abstract] [PDF]


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