Hyperprolactinemia: Monitoring children on long-term risperidone
How to address evidence of potential for developmental effects with sustained use.
Elevation with symptoms. Intervene if serum prolactin is elevated and your patient has clinical symptoms of hyperprolactinemia. Consider gradually tapering risperidone over 2 weeks and switching to a prolactin-sparing antipsychotic such as aripiprazole. If serum prolactin is >200 ng/mL or is persistently elevated despite switching to a prolactin-sparing antipsychotic, obtain an MRI of the sella turcica to look for a pituitary adenoma or parasellar tumor.
Use of dopamine agonists. Few studies have evaluated the safety and efficacy of using dopamine agonists such as cabergoline or amantadine to resolve the effects of hyperprolactinemia.26,27 Further research is warranted before this approach can be recommended.
Related resources
- Masi G, Cosenza A. Prolactin levels in young children with pervasive developmental disorders during risperidone treatment. J Child Adolesc Psychopharmacol 2001;11:389-94.
- Cheng-Shannon J, McGough JJ, Pataki C, McCracken JT. Second-generation antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol 2004;14:372-94.
Drug brand names
- Amantadine • Symmetrel
- Aripiprazole • Abilify
- Cabergoline • Dostinex
- Clozapine • Clozaril
- Haloperidol • Haldol
- Olanzapine • Zyprexa
- Quetiapine • Seroquel
- Risperidone • Risperdal
- Ziprasidone • Geodon
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
