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Short- and long-term effects on prolactin of risperidone and olanzapine treatments in children and adolescents

PROGRESS IN NEURO-PSYCHOPHARMACOLOGY & BIOLOGICAL PSYCHIATRY (2009)

Journal

PROGRESS IN NEURO-PSYCHOPHARMACOLOGY & BIOLOGICAL PSYCHIATRY

Volume 33, Issue 8, Pages 1496-1501

Publisher

PERGAMON-ELSEVIER SCIENCE LTD

DOI: 10.1016/j.pnpbp.2009.08.009

Keywords

Children; Olanzapine; Prolactin; Risperidone; Tolerance

Funding

AstraZeneca
NIH

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Abstract

This study investigated prolactin levels in two groups of children and adolescents receiving risperidone (N= 29) or olanzapine (N= 13). It focused not only on significant differences but also on effect sizes; took into account dose effects and gender differences; used a longitudinal design (months 1, 3, 6 and 12) that helped control for individual differences; and took into account response differences due to the duration of antipsychotic treatment. Additionally, this study investigated tolerance development using statistical tests, and explored the effect of antipsychotic plasma concentrations at months 1 and 3. After adjusting for gender, treatment duration and individual effects, mean prolactin levels on risperidone were 4.9 ng/mL higher than on olanzapine (10.3 times higher after controlling for dosing potency). On risperidone treatment, the adjusted mean prolactin level at the 3rd month of treatment was significantly higher than at the 1st month; at the 12th month it was significantly lower than at the 1st month; the 1st and 6th months were not significantly different. On olanzapine treatment, adjusted mean prolactin levels at the 3rd and 6th months of treatment were significantly higher than at the 1st month; at the 12th month it was lower than at the 1st month, but the difference was not significant. In males, at the 3rd month, an increase of 1ng/mL in plasma 9-hydroxyrisperidone concentrations raised prolactin levels significantly by 0.44 ng/mL In females, independently of duration (1 or 3 months), an increase of 1 ng/mL in plasma olanzapine concentrations raised prolactin levels significantly by 2.1 ng/mL. After adjusting for dose and the greater potency of risperidone, the increase in prolactin levels during risperidone treatment appeared to be 10.3 times higher than that during olanzapine treatment. Our study showed a pattern consistent with the development of prolactin tolerance over time. Future prolactin studies in children and adolescents taking antipsychotics need to include larger samples with more frequent prolactin measures and long-term plasma concentrations. (C) 2009 Elsevier Inc. All rights reserved.

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Relapse in patients with schizophrenia and amisulpride-induced hyperprolactinemia or olanzapine-induced metabolic disturbance after switching to other antipsychotics

Jingda Cai, Li Li, Tiannan Shao, Mengxi Sun, Weiyan Wang, Peng Xie, Xiaoyi Wang, Ye Yang, Yujun Long, Dongyu Kang, Jingmei Xiao, Yuhan Su, Xingjie Peng, Yuyan Huang, Menghui Gao, Qiongqiong Wu, Chuhan Song, Furu Liu, Ping Shao, Jianjun Ou, Yidong Shen, Jing Huang, Renrong Wu

Summary: Hyperprolactinemia and metabolic disturbance are common side effects of antipsychotics. This study investigated the relationship between antipsychotic switching, baseline clinical status, metabolic changes, and relapse in patients with schizophrenia. The results showed that patients with higher baseline symptoms were more likely to relapse, and switching to aripiprazole increased the risk of relapse regardless of the original medication. Changes in medication also had different effects on metabolic indices in patients with different baseline drugs.

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