A Case Report of Antipsychotic-Induced Hyperprolactinemia Managed With Adjunctive Aripiprazole

Author

Astha Dubey, Mr. Arpan Debnath, Dr. Siddharth Verma


Abstract

 Antipsychotic-induced hyperprolactinemia is a clinically important adverse drug reaction caused primarily by dopamine D2-receptor blockade in the tuberoinfundibular pathway. Elevated prolactin may lead to galactorrhea, menstrual disturbance, sexual dysfunction, infertility, and, with persistent exposure, adverse skeletal consequences. This case report describes a clinical scenario illustrating the recognition and pharmacological management of symptomatic hyperprolactinemia associated with risperidone. A 29-year-old woman receiving stable risperidone therapy for schizophrenia developed secondary amenorrhea, galactorrhea, and reduced libido. Pregnancy, primary thyroid dysfunction, and other common secondary causes were excluded. Serum prolactin was markedly elevated while the patient remained psychiatrically stable. Rather than abruptly discontinuing effective antipsychotic therapy, low-dose adjunctive aripiprazole was introduced with continued clinical monitoring. A progressive reduction in prolactin and resolution of galactorrhea and menstrual symptoms were observed in the follow-up scenario without deterioration in psychiatric status. The pharmacological rationale is based on the partial agonist activity of aripiprazole at dopamine D2 receptors and published clinical evidence demonstrating prolactin-lowering effects when aripiprazole is added to prolactin-raising antipsychotics.


Keywords

antipsychotics; hyperprolactinemia; risperidone; aripiprazole; dopamine D2 receptor; adverse drug reaction; pharmacovigilance.



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References


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