Erhan KURT, H. Murat EMUL, E. Timuçin ORAL

Yeni antipsikotikler ve haloperidolün prolaktin üzerindeki etkilerinin karşılaştırılması

Amaç: Bu natüralistik izleme çalışması ile, şizofreni veya sanrılı bozukluk tanılı hastalarda haloperidol ve yeni antipsikotiklerin prolaktin düzeyi üzerindeki etkilerinin karşılaştırılması amaçlanmıştır. Yöntem: Çalışmaya en az bir haftadır (depo/uzun etkili antipsikotik alanlarda bir aydır) ilaç kullanmayan 109 hasta ile başlanmış, sonuçta klasik antipsikotik kullanan hastalardan haloperidol alanlarla, yeni antipsikotik ilaçlardan klozapin, olanzapin, risperidon, ketiyapin veya sülpirid kullanan 64 hasta istatistiksel değerlendirmeye tabi tutulmuştur. Hastaların tedavi protokollerine müdahale edilmemiştir. Çalışmanın başlangıcında ve en az 2 ay sonra, ilacını düzenli kullanan hastaların prolaktin değerleri ölçülmüştür. Bulgular: Çalışmaya alınan hastalar arasında haloperidol, sülpirid ve risperidon kullananların kan prolaktin düzeyinde iki ay sonra anlamlı artış bulunmuştur. Klozapin, olanzapin ve ketiyapin kullanan hastaların prolaktin düzeyinde çalışma öncesine göre, iki ay sonra herhangi bir değişiklik bulunmamıştır. Sonuç: Antipsikotiklerin, şizofreni ve diğer psikotik bozuklukların tedavisinde yaygın kullanımıyla birlikte hiperprolaktinemi gibi endokrin yan etkiler akılda tutulmalıdır. Eşlik eden başka bir belirti olmaksızın hiperprolaktinemi, çoğu zaman ciddi ve ilacı kesmeye neden olacak bir sorun olarak görülmemektedir. Yine de hiperprolaktinemi saptanan hastalarda tedavi gözden geçirilmeli ve gerek görülürse ileri endokrinolojik değerlendirme yapılmalıdır.

Anahtar Kelimeler:

Psikiyatrik durum derecelendirme ölçekleri, Şizofreni, Haloperidol, Prolaktin, Antipsikotik ajanlar

Comparison of the influences of new genaration antipsychotics and haloperidol on prolactin levels

Objective: The aim of this naturalistic study was to compare the influence of haloperidol and new generation antipsychotics on prolactin levels is in patients with schizophrenia or delusional disorder. Methods: The participants were 109 patients who were drug free at least for one week (for depot/long action antipsychotic users, drug free at least one month) at the beginning. The data of 64 patients who were receiving haloperidol, clozapine, olanzapine, risperidone, quetiapine or sulpiride were analyzed. No intervention was made to the treatment regimens of the patients. The blood prolactin levels of the patients were measured at the beginning and after the second month of the treatment who had complied with the treatment regimens. Results: In haloperidol, risperidone, and sulpiride groups, the blood prolactin level was found to be increased significantly after two months. There were no significant changes in prolactin levels among clozapine, olanzapine and quetiapine receivers two moths later. Conclusion: Within the widespread use of antipsychotics in schizophrenia and other psychotic disorders, the endocrinological side effects related with drug use like hyperprolactinemia should be kept in mind. Hyperprolactinemia without any comorbidity is not seen a serious problem to cease the treatment.However, the treatment should be revised in a patient with hyperprolactinemia and if needed, further endocrinological examinations should be made.

Keywords:

Psychiatric Status Rating Scales, Schizophrenia, Haloperidol, Prolactin, Antipsychotic Agents,

PDF

___

1. Petty RG. Prolactin and antipsychotic medications: mechanism of action. Schizophr Res 1999; 35(Suppl.):S67-73.
2. Goodnick PJ, Rodriguez L, Santana O. Antipsychotics: impact on prolactin levels. Expert Opin Pharmacother 2002; 20:365-373.
3. Conley RR. Risperidone side effects. J Clin Psychiatry 2000; 61(Suppl.8):52-61.
4. Compton MT, Miller AH. Antipsychotic-induced hyperprolactinemia and sexual dysfunction. Psychopharmacol Bull 2002; 36:143-164.
5. Haddad PM, Wieck A. Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management. Drugs 2004; 64:2291-2314.
6. Zhang XY, Zhou DF, Cao LY, Zhang PY, Wu GY, Shen YC. Prolactin levels in male schizophrenic patients treated with risperidone and haloperidol: a double blind and randomized study. Psychopharmacology 2005; 178:35-40.
7. Dickson RA, Glazer WM. Hyperprolactinemia and male sexual dysfunction. J Clin Psychiatry 1999; 60:125.
8. Rosen CJ, Kessenich JR. The pathophysiology and treatment of postmenopausal osteoporosis. An evidence-based approach to estrogen replacement therapy. Endocrinol Metab Clin North Am 1997; 26:295-311.
9. Naidoo U, Goff DC, Klibanski A. Hyperprolactinemia and bone mineral density: the potential impact of antipsychotic agents. Psychoneuroendocrinology 2003; 28(Suppl.2):97-108.
10. First MB, Spitzer RL, Gibbon M, Williams JBW. DSM-IV Eksen Bozuklukları İçin Yapılandırılmış Klinik Görüşme. SCID-I. A Çorapçıoğlu (çev.), Ankara, Hekimler Yayın Birliği, 1999.
11. Eşel E, Baştürk M, Gönül AS, Kula M, Turan MT, Yabanoğlu İ, ve ark. Şizofrenik hastalarda olanzapin ve haloperidolün serum prolaktin düzeyleri üzerine etkileri. Klinik Psikiyatri Dergisi 2000; 3:246-249.
12. Beasley CM, Hamilton SH, Crawford AM, Dellva MA, Tollefson GD, Tran PV, et al. Olanzapine versus haloperidol: acute phase results of international double-blind olanzapine trail. Psychopharmacology 1997; 124:159-167.
13. Callaghan JT, Bergstrom RT, Ptak LR. Olanzapine. Pharmacokinetic and pharmacodynamic profile. Clin Pharmacokinet 1999; 37:177-193.
14. Crawford AM, Beasley CM, Tollefson GD. The acute and long-term effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations. Schizophr Res 1997; 26:41-54.
15. Kapur S, Zipursky RB, Remigton G, Jones C, DaSilva J, Wilson AA, et al. 5-HT2 and D2 receptor occupancy of olanzapine in schizophrenia: a PET investigation. Am J Psychiatry 1998; 155:921-928.
16. Kapur S, Zipursky RB, Remigton G. Clinical and theoretical implications of 5-HT2 and D2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia. Am J Psychiatry 1999; 156:286-293.
17. Schlegel S, Schlosser R, Hiemke C, Nickel O, Bockisch A, Hahn K. Prolactin plasma levels and D2-dopamine receptor occupancy measured with IBZM-SPECT. Psychopharmacology 1996; 124:285-287.
18. Farde L, Nordstrom AL, Wiesel FA, Pauli S, Halldin C, et al. Positron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine: relation to extrapyramidal side effects. Arch Gen Psychiatry 1992; 49:538-544.
19. Hammer M. The effects of atypical antipsychotics on serum prolactin levels. Ann Clin Psychiatry 2002; 14:163-173.
20. David SR, Taylor CC, Kinon BJ, Breier A. The effects of olanzapine, risperidone, and haloperidol on plasma prolactin levels in patients with schizophrenia. Clin Ther 2000; 2:1085-1096.
21. Martina H, Johannes H. Hyperprolactinaemia and antipsychotic therapy in schizophrenia. Current Med Res and Opin 2004; 20:189-197.