Medine Gıynaş AYHAN, Faruk UĞUZ, Nazmiye KAYA

Risperidona bağlı gelişen hiperprolaktineminin tedaviye aripiprazol eklenmesiyle düzelmesi

Amaç: Hiperprolaktinemi antipsikotik tedavisinin önemli bir yan etkisidir. Tipik antipsikotiklerin hepsi ve atipik antipsikotiklerden risperidon ve amisülpiridin serum prolaktin seviyesini yükselttiği bilinmektedir. Atipik antipsikotiklerden ketiapin, olanzapin, klozapin, ziprasidon ve aripiprazolün serum prolaktin düzeylerini çok az ya da hiç yükseltmediği ileri sürülmektedir. Hiperprolaktinemi jinekomasti, galaktore, cinsel işlev bozukluğu, infertilite, oligomenore ve amenoreye neden olmaktadır. Ayrıca kemik mineral yoğunluğunu azaltarak osteoporoza yol açmaktadır. Bu önemli yan etkiler, remisyona girmiş hastaların tedaviye devam etmesinde sorun oluşturmaktadır. Olgu Sunumu: Risperidon ile yanıt alınmış ancak hiperprolaktinemi ve buna bağlı amenore gelişmiş iki hastanın tedavisine aripiprazol eklenmesiyle prolaktin seviyelerinin düşmesi anlatılmıştır. Sonuç: Psikotik belirtilerde belirgin düzelme olup hiperprolaktinemi gelişen olgularda tedaviye aripiprazol eklenmesi ilk seçenek olarak düşünülebilir.

Improvement of risperidone-induced hyperprolactinemia with the addition of aripiprazole

Objective: Hyperprolactinemia is an important side effect of antipsychotic treatment. All of typical antipsychotics and atypical antipsychotics such as risperidone and amisulpiride have been shown to cause marked elevation in serum prolactin levels, whereas most other atypical antipsychotics such as quetiapine, olanzapine, clozapine, ziprasidone and aripiprazole appear to have little or no affect on serum prolactin levels. Hyperprolactinemia can lead to gynecomastia, galactorrhea, sexual dysfunction, infertility, oligomenorrhea and amenorrhea. It also reduces the bone mineral density contributes to osteoporosis in a long term. These important side effects cause patients in remission not to continue treatment. Case Report: We report two clinical cases treatment of risperidone-induced hyperprolactinemia and amenorrhea by the partial dopamine agonist aripiprazol induces prolactine normalization. Conclusion: Addition of aripiprazole to treatment may be considered as a first option in cases significant improvement in psychotic symptoms with hyperprolactinemia.

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