Management of psychotropic-induced hyperprolactinemia.
Management of psychotropic-induced hyperprolactinemia.
复制标题
精神药物引起的高催乳素血症的治疗。
作者：
P. Marken;R. Haykal;J. Fisher
描述了个别精神药物对血清催乳素浓度的影响，并提供了处理不良反应的建议。高泌乳素血症可导致溢乳、闭经、月经不调和不排卵；男性可能会出现阳痿和无精症，无论是否有哺乳期和男性乳房发育症。抗精神病药可能会阻断垂体催乳素分泌细胞中的多巴胺受体，并防止多巴胺诱导的催乳素释放减少。催乳素浓度增加的幅度与抗精神病药物的用量相关。选择的治疗方法是减少抗精神病药物剂量或停止治疗。如果调整抗精神病药物剂量未能解决症状，可以尝试多巴胺激动剂溴隐亭和金刚烷胺。抗抑郁药可能会导致血清催乳素浓度升高，尤其是长期服用。然而，抗抑郁药引起的高催乳素血症的发生率远低于抗精神病药，并且严重的不良临床反应并不常见。其他精神药物，如锂、丙戊酸、丁螺环酮、卡马西平和苯二氮卓类药物，很少与症状性高催乳素血症相关，或者不会产生临床上重要的催乳素浓度变化。抗精神病药物是最有可能引起症状性高催乳素血症的精神药物。如果停药或调整抗精神病药物剂量不能消除症状，溴隐亭或金刚烷胺可以缓解症状。
The effects of individual psychotropic medications on serum prolactin concentrations are described, and recommendations for dealing with adverse effects are provided. Hyperprolactinemia can result in galactorrhea, amenorrhea, irregular menses, and anovulation; in men, impotence and azoospermia, with or without lactation and gynecomastia, can occur. Antipsychotics may block dopamine receptors in the pituitary prolactin-secreting cells and prevent dopamine-induced reduction of prolactin release. The magnitude of the increase in prolactin concentration correlates with the amount of antipsychotic drug given. The treatment of choice is reduction of the antipsychotic dosage or discontinuation of therapy. If adjustments to the antipsychotic dosage fail to resolve symptoms, the dopamine agonists bromocriptine and amantadine may be tried. Antidepressants may produce elevated serum prolactin concentrations, especially with long-term administration. However, the frequency of antidepressant-induced hyperprolactinemia is much lower than that seen with antipsychotics, and serious adverse clinical effects are uncommon. Other psychotropic drugs such as lithium, valproic acid, buspirone, carbamazepine, and benzodiazepines either are only rarely associated with symptomatic hyperprolactinemia or do not produce clinically important changes in prolactin concentrations. Antipsychotic drugs are the psychotropic agents most likely to cause symptomatic hyperprolactinemia. Bromocriptine or amantadine may provide symptomatic relief if withdrawal or adjustment of the antipsychotic dosage does not eliminate the symptoms.