Management of Hyperprolactinemia with Antipsychotics

Antipsychotic Selection

• The American Psychiatric Association recommends avoiding dopamine D2 antagonists and antipsychotic polypharmacy in patients with hyperprolactinemia, as they can increase prolactin elevation and worsen related complications 1, 2
• Antipsychotic polypharmacy with D2 antagonists is associated with increased prolactin elevation compared to monotherapy, and can lead to a higher global side-effect burden including worsening hyperprolactinemia, sexual dysfunction, and related complications 1, 2

Monitoring Considerations

• Prolactin levels should be monitored in patients taking antipsychotics, particularly in women of childbearing age and immunocompromised patients, as hypoprolactinemia can negatively impact fertility and immune function 1, 2