Posted by ed_uk2010 on October 3, 2014, at 7:18:05
In reply to Re: Advice, posted by mogger on October 2, 2014, at 10:59:21
>Thanks so much for your advice! I am hoping my doctor is open to adding Abilify as he has said it can exacerbate ocd and has a high incidence for akathisia which I tend to get. I see Bromocriptine is also used to treat Risperidone hyperprolactinaemia as it is a dopamine agonist. Many thanks for your help!
>
> JosephHi,
There are several concerns about bromocriptine:
1. As a full dopamine D2 agonist, it can potentially cause or aggravate psychiatric symptoms.
2. There is a risk of certain irreversible side effects after long-term use eg. fibrosis/scarring of the heart valves or lung tissue. The frequency of minor side effects is also rather high!
As such, it is no longer a popular treatment for hyperprolactinemia of any cause. Cabergoline and quinagolide are preferred for hyperprolactinemia causes by pituitary tumors. Aripiprazole is preferred for hyperprolactinemia causes by antipsychotics.
First, you should have a blood test to check your prolactin level. Assuming it's elevated, you could add 2mg or 2.5mg of aripiprazole per day. A low starting dose should help to minimise adverse effects such as akathisia, or any other symptom exacerbation. If akathisia occurs with Abilify, it tends to wear off as you adjust to the medication.... unlike older antipsychotics. You could potentially use a benzodiazepine for a few days if it makes you restless. If tolerated, you could then increase Abilify to 5mg and repeat the prolactin level after a few weeks. Sexual function should improve within a few weeks.
Some evidence which you may find helpful....
Here is a little study in women, who tend to suffer greater elevations in prolactin (hyperprolactinemia) and more symptoms. It suggests that aripiprazole exerts an effect even at 3mg per day, and that doses above 6mg are not normally needed. In practice, 2-5mg would be used, unless you want to measure awkward doses using Abilify liquid!
J Clin Psychopharmacol. 2010 Oct.
Dose-dependent effects of adjunctive treatment with aripiprazole on hyperprolactinemia induced by risperidone in female patients with schizophrenia.
Abstract
Hyperprolactinemia is a frequent consequence of treatment with risperidone. Recent studies have suggested that aripiprazole, a partial dopamine agonist, reduces the prolactin response to antipsychotics. Thus, we examined the dose effects of adjunctive treatment with aripiprazole on the plasma concentration of prolactin in patients who had elevated prolactin levels because of risperidone treatment.
Aripiprazole was concomitantly administrated to 16 female patients with schizophrenia receiving 2 to 15 mg/d of risperidone. Dosages of aripiprazole were gradually increased from 3 to 12 mg/d with 2- to 4-week intervals. Sample collections for prolactin were conducted before aripiprazole administration (baseline) and 2 to 4 weeks after the dose escalation of aripiprazole and just before next dose escalation. The samples were taken just before the morning dose.
The plasma concentration of prolactin during aripiprazole administration (3, 6, 9, or 12 mg/d) was significantly lower than that at baseline. The mean (±SD) percent reductions at 3, 6, 9, and 12 mg/d were 35% ± 14%, 54% ± 17%, 57% ± 19%, and 63% ± 17%, respectively. However, neither the plasma concentration of prolactin nor the reduction ratio differed among the dosages of 6, 9, and 12 mg/d of aripiprazole. Three out of 8 patients with amenorrhea improved after 12 mg/d of aripiprazole.
The present study suggests that adjunctive treatment with aripiprazole reduces the prolactin concentration that had been increased because of risperidone treatment. The effect occurs even when a low dosage (3 mg/d) of aripiprazole was used and achieves a plateau at dosages beyond 6 mg/d.
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Here is another study looking at the efficacy of adding aripiprazole. It shows that aripiprazole normalised prolactin levels in the majority of patients treated with risperidone, but was only of marginal use when added to amisulpride or sulpiride. (Hyperprolactinemia caused by the latter two drugs is difficult to manage).
Prog Neuropsychopharmacol Biol Psychiatry. 2010 Dec 1.
Differential add-on effects of aripiprazole in resolving hyperprolactinemia induced by risperidone in comparison to benzamide antipsychotics.
Abstract
Hyperprolactinemia is associated with typical antipsychotic agents and atypical antipsychotics such as risperidone and amisulpride. This study investigates the effects of 8-week adjunctive treatment with aripiprazole in patients with hyperprolactinemia induced by risperidone in comparison to benzamide antipsychotics (amisulpride and sulpiride). Aripiprazole was administered to 24 patients with antipsychotic-induced hyperprolactinemia. The doses of pre-existing antipsychotics were fixed, while the aripiprazole dose was 5-20 mg/day during the 8-week study period. Serum prolactin levels were measured at weeks 4 and 8. Symptoms and side effects were assessed using the Positive and Negative Syndrome Scale (PANSS), Arizona Sexual Experience Scale, Abnormal Involuntary Movement Scale, Simpson-Angus Scale, Barnes Akathisia Scale, and metabolic measures at weeks 2, 4 and 8.
Mean (standard error) prolactin levels decreased from 77.0±13.3 ng/mL to 18.3±2.1 ng/mL (p<0.001 vs. baseline), from 144.9±24.4 ng/mL to 127.5±21.7 ng/mL (p=0.099 vs. baseline) and 71.4±24.6 ng/mL to 43.3±14.7 ng/mL (p=0.106 vs. baseline) for those taking risperidone, amisulpride, and sulpiride, respectively.
For those who took risperidone before the study started, 14 of 15 (93.3%) patients had normalized prolactin levels, while only 1 of 10 (10%) taking benzamide antipsychotics had normalized prolactin levels. The PANSS score improved significantly, and aripiprazole had no significant influence on metabolic measures or scales of movement side effects.
Adjunctive aripiprazole treatment reversed effectively hyperprolactinemia induced by risperidone, but was less effective for that induced by benzamide antipsychotics.
...There are various other little studies too, it's certainly the best established option so far.
poster:ed_uk2010
thread:1071594
URL: http://www.dr-bob.org/babble/20140914/msgs/1071770.html