Prolactin Screening in a Prolactin Screening in a Cohort of Cohort of

Schizophrenia Patients Schizophrenia Patients in Small Heath, in Small Heath,

BirminghamBirminghamDr Imran WaheedDr Imran Waheed

Consultant in Adult PsychiatryConsultant in Adult Psychiatry

2424thth February 2009 February 2009

AimsAims

To establish the numerical To establish the numerical prevalence and severity of raised prevalence and severity of raised prolactin levels in apparently prolactin levels in apparently asymptomatic patients.asymptomatic patients.

To make recommendations about the To make recommendations about the feasibility of routine prolactin feasibility of routine prolactin screening.screening.

MethodMethod All patients with a diagnosis of schizophrenia receiving All patients with a diagnosis of schizophrenia receiving

antipsychotics had annual prolactin measurements.antipsychotics had annual prolactin measurements. All outpatients or inpatients at Small Heath Health Centre All outpatients or inpatients at Small Heath Health Centre

were included.were included. The patient cohort consisted of schizophrenia outpatients who The patient cohort consisted of schizophrenia outpatients who

either attend the CMHT or agreed to have a prolactin sample either attend the CMHT or agreed to have a prolactin sample taken at their home and schizophrenia inpatients. taken at their home and schizophrenia inpatients.

Prolactin samples were taken between 0900-1300.Prolactin samples were taken between 0900-1300. The Upper Limit of Normal (ULN) for prolactin as set by the The Upper Limit of Normal (ULN) for prolactin as set by the

hospital pathology service is 324 mIU/L (males) and 496 hospital pathology service is 324 mIU/L (males) and 496 mIU/L (females). mIU/L (females).

The patient's name, age, unit number, ethnicity, details of The patient's name, age, unit number, ethnicity, details of current medication, recent changes to medication and current medication, recent changes to medication and symptoms of hyperprolactinaemia were recorded on the study symptoms of hyperprolactinaemia were recorded on the study proforma.proforma.

3631 Male

Female

Results – Sample by Gender

98 8 8

7

54 4 4 4 4

2

0123456789

10Risperidone Oral

Risperdal Consta

Depixol DepotOlanzapine

Clozapine

Quetiapine

AmisulpirideClozapine/Amisulpiride

Aripiprazole

Modecate Depot

Clopixol DepotHaldol Depot

Sample: Anti-psychotic

3433Hyperprolactinaemia

Within normal range

Hyperprolactinaemia

Normal Range (Female 102-496/Male 86-324)

789

497

1100

0

200

400

600

800

1000

1200

Overall

Male

Female

Mean Prolactin

1668

1038929

794756675

303281274263237153

0200400600800

10001200140016001800

Risperidone Oral

Clozapine/Amisulpiride

Haldol DepotRisperidone Consta

Amisulpiride

Depixol

Clopixol DepotQuetiapine

Olanzapine

Modecate

ClozapineAripiprazole

Mean Prolactin by anti-psychotic

0102030405060708090

100

Risperidone Oral

Risperidone Consta

Amisulpiride

Olanzapine

Aripiprazole

Quetiapine

How common is hyperprolactinaemia?

Risperidone CohortRisperidone Cohort 9 patients on oral risperidone. 9 patients on oral risperidone. 8 patients on risperidone long acting injection. 8 patients on risperidone long acting injection. All patients (All patients (n=17n=17) on oral/IM risperidone had ) on oral/IM risperidone had

hyperprolactinaemia.hyperprolactinaemia. Oral risperidone – mean prolactin 1668 mIU/LOral risperidone – mean prolactin 1668 mIU/L Risperdal Consta – mean prolactin 794 mIU/LRisperdal Consta – mean prolactin 794 mIU/L Patients treated with Risperdal Consta have lower Patients treated with Risperdal Consta have lower

average prolactin values than patients treated with average prolactin values than patients treated with oral risperidone. oral risperidone.

Results - SummaryResults - Summary 67 patients had prolactin measurements. 67 patients had prolactin measurements. 51 % of the cohort had hyperprolactinaemia. 51 % of the cohort had hyperprolactinaemia. 26 % of the cohort had significantly abnormal levels 26 % of the cohort had significantly abnormal levels

(>1000 mIU/L) that should lead to consideration of (>1000 mIU/L) that should lead to consideration of drug/dosage alterations.drug/dosage alterations.

The mean prolactin of the cohort was 497 miU/L in The mean prolactin of the cohort was 497 miU/L in males and 1100 miU/L in females. males and 1100 miU/L in females.

All patients on risperidone (oral or injection) and All patients on risperidone (oral or injection) and amisulpiride had hyperprolactinaemia. amisulpiride had hyperprolactinaemia.

Switching case studySwitching case study Carol is a 36 year old female with paranoid Carol is a 36 year old female with paranoid

schizophreniaschizophrenia At the time of the initial prolactin screen she was on At the time of the initial prolactin screen she was on

Depixol 60 mg every 2 weeksDepixol 60 mg every 2 weeks Prolactin was found to be 1038 mIU/LProlactin was found to be 1038 mIU/L Amenorrhea, galactorrhea, reduced libido, sexual Amenorrhea, galactorrhea, reduced libido, sexual

dysfunctiondysfunction Switched to olanzapine 10 mg dailySwitched to olanzapine 10 mg daily 6 weeks later – increased libido, periods returned – 6 weeks later – increased libido, periods returned –

advice given on contraception – mental state advice given on contraception – mental state remained stableremained stable

No weight gain/glucose tolerance changes – repeat No weight gain/glucose tolerance changes – repeat prolactin was 274 mIU/L.prolactin was 274 mIU/L.

RecommendationsRecommendations Due to the high prevalence of Due to the high prevalence of

hyperprolactinaemia, consideration should be hyperprolactinaemia, consideration should be given to routine prolactin monitoring, given to routine prolactin monitoring, particularly for those patients on prolactin particularly for those patients on prolactin elevating anti-psychotics.elevating anti-psychotics.

Medical and nursing staff must ensure that Medical and nursing staff must ensure that they enquire about the common symptoms they enquire about the common symptoms associated with hyperprolactinaemia (including associated with hyperprolactinaemia (including use of LUNSERS).use of LUNSERS).

Consideration must be given to drug or dosage Consideration must be given to drug or dosage alterations in those patients with significantly alterations in those patients with significantly elevated prolactin levels. elevated prolactin levels.

Prolactin Screening in a Prolactin Screening in a Cohort of Cohort of

Schizophrenia Patients Schizophrenia Patients in Small Heath, in Small Heath,

BirminghamBirminghamDr Imran WaheedDr Imran Waheed

Consultant in Adult PsychiatryConsultant in Adult Psychiatry

2424thth February 2009 February 2009