Which of the following Anti-psychotic drug has maximum chances of causing hyperprolactinemia?
(D) Risperidone[?]RISPERIDONE is one of the atypical neuroleptics most likely to induce hyperprolactinemia.Mechanism: Dopamine acts on the pituitary as an inhibitor of prolactin secretion.Blockade of dopamine D2 receptors by risperidone can cause hyperprolactinemia in males and females.Other atypical antipsychotics do not cause sustained hyperprolactinemia because of their lower affinity for D2 receptors.Combination of D2+5-HT2 receptor blockade.In addition it has high affinity forAlpha 1Alpha2 & H1 receptorsBlockade of these may contribute to efficacy as well as side effects like postural hypotension.Risperidone is more potent D2 blocker than clozapine; extrapyramidal side effects are less only at low doses (<6mg/day).Prolactin levels rise during risperidone therapy, but it is less epileptogenic than clozapine.Caution: Increased risk of stroke in the elderly.Risperidone Side Effects:Prolactin elevation, probably greater than that seen with the typical neuroleptics.Agitation: This can look like akathisia, or it may present as hypomania or mania. It is unclear whether these reports represent true side effects of the atypicals or coincidental exacerbations of the patient's underlying condition.Anxiety, insomnia, headache & nausea.Weight gain and the metabolic syndrome - low to medium risk.About other options:Clozapine: almost no effectsOlanzapine, ziprasidone: limited effectsThe hyperprolactinemia from antipsychotic drugs is rapidly reversible when the drugs are discontinued.DRUGS CAUSING HYPERPROLACTINEMIAMedication ClassFrequency of Prolactin ElevationMechanismAntipsychotics*. Chlorpromazine*. Haloperidol*. Loxapine*. Risperidone*. PaliperidoneModerateHighModerateHighHighDopamine (D2) Receptor BlockadeCyclic Antidepressants*. Amitriptyline*. Desipramine*. Clompramine*. NortriptylineLowLowHighNoneIndirect PRL affect via serotoninAnti-emetics*. Metodopramide*. Prochlorperazine Dopamine (D2) Receptor BlockadeAntihypertinsives*. Verapamil*. Methyldopa Not understood Decreased DA synthesis LIST OF DRUGS KNOWN TO CAUSE HYPERPROLACTINEMIA AND/OR GALACTORRHEATypical antipsychotics*. Chlorpromazine*. Clomipramine*. Fluzphenazine*. Prochlorperazine*. Thioridazine*. Haloperidol*. PrimozideGastrointestinal drugs*. Cimetidine*. MetoclopramideAtypical Antipsychotis*. Risperidone*. Molindone*. OlanzapineAnti hypertensive agents*. Methyldopa*. Reserpine*. Verapamil*. Opiates*. Codeine*. MorphineAntidepressant agents*. Clomipramine*. Desipramine
Clozapine
Olanzapine
Ziprasidone
Risperidone
Pharmacotherapy In Psychiatry