Clinical outcomes and serum prolactin levels in patients with antipsychotic-induced hyperprolactinemia following different management strategies.

OBJECTIVE

To evaluate the effects of different management strategies (watchful waiting, dose reduction, switching and adjunctive treatments) on prolactin levels and clinical outcomes in patients with antipsychotic-induced hyperprolactinaemia.

METHODS

A prospective cohort study was conducted with 135 adult patients diagnosed with hyperprolactinaemia due to antipsychotic use. Patients were assigned to four management groups: watchful waiting, dose reduction, switching and adjunctive treatment (with aripiprazole). Prolactin levels and clinical symptoms (e.g. galactorrhea, gynaecomastia, menstrual irregularities) were assessed before and after intervention.

RESULTS

Baseline prolactin levels were comparable across groups. Post-intervention, all groups exhibited significant reductions in prolactin levels, with the largest decrease observed in the switching and adjunctive treatment group (mean change: -68.3 and -67.1 ng/mL, respectively). Clinical outcomes also improved, with a notable reduction in galactorrhea (p = 0.04), gynaecomastia (p = 0.004) and menstrual irregularities across all groups (p = 0.02). No significant changes were observed in sexual dysfunction, hirsutism or acne.

CONCLUSION

Management strategies for antipsychotic-induced hyperprolactinaemia, particularly switching or adjunctive treatments, effectively reduce prolactin levels and improve related symptoms.