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Evidence for the Partial Dopamine-Receptor Agonist Aripiprazole as a First-Line Treatment of Psychosis in Patients With Iatrogenic or Tumorogenic Hyperprolactinemia

Received April 4, 2008; revised May 20, 2008; accepted May 28, 2008. From the Dept. of Psychiatry and the Dept. of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA. Send correspondence and reprint requests to Maju Matthews, M.D., Friends Hospital, 4641 Roosevelt Boulevard, Philadelphia, PA 19124. e-mail: maju_matthews{at}yahoo.com
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Antipsychotic drugs have many side effects, including elevation of prolactin levels through tuberoinfundibular dopamine-receptor blockade. Although a number of studies claim that aripiprazole is a prolactin-sparing antipsychotic drug that may even lower prolactin levels, there has not been an exhaustive evaluation of this claim. OBJECTIVE: The authors analyzed the burgeoning literature suggesting that aripiprazole is efficacious in treating iatrogenic and tumorogenic hyperprolactinemia. METHOD: The authors conducted a literature search for case studies, reports, and placebo-controlled trials that measured prolactin levels in adult patients taking aripiprazole. RESULTS: The search identified 17 studies, in which 3,489 psychotic patients were given aripiprazole alone, as an adjuvant to haloperidol or risperidone, or to treat psychosis with a concomitant prolactinoma. Across all studies, aripiprazole lowered prolactin levels an average of 74.3%, even in psychotic patients with prolactinoma, whereas haloperidol and risperidone increased prolactin levels by as much as 272%. CONCLUSION: These findings suggest that aripiprazole may play an important niche role in treating psychotic patients sensitive to elevated prolactin and patients with prolactin-secreting pituitary tumors.

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