From the Guidelines
To treat lactation caused by risperidone, the most effective approach is to reduce or discontinue the medication under psychiatric supervision, or switch to an antipsychotic with lower prolactin-raising potential, and for those who cannot change medications, cabergoline (0.25-1 mg twice weekly) is recommended as the first-line dopamine agonist therapy. Risperidone-induced hyperprolactinemia occurs because the drug blocks dopamine D2 receptors in the tuberoinfundibular pathway, leading to increased prolactin levels and potentially causing galactorrhea (milk production) [ 1 ]. Some key points to consider when treating lactation caused by risperidone include:
- Reducing or discontinuing risperidone under psychiatric supervision
- Switching to an antipsychotic with lower prolactin-raising potential such as aripiprazole, quetiapine, or olanzapine
- Adding dopamine agonists like cabergoline to counteract the prolactin elevation, with careful monitoring for potential interference with the antipsychotic's therapeutic effect [ 1 ]
- Regular prolactin level monitoring, with baseline levels before starting treatment and follow-up measurements at 3 months and then annually
- Assessing patients for other hyperprolactinemia symptoms like menstrual irregularities, sexual dysfunction, or bone density changes In cases where standard doses of cabergoline are not effective, graduated dose increments of up to 3.5 mg per week or up to 7 mg per week in exceptional cases may be considered [ 1 ]. It is essential to prioritize the patient's psychiatric stability and carefully weigh the benefits and risks of any treatment adjustments, considering the potential impact on their mental health and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Risperidone-Induced Hyperprolactinemia
- Reducing the dose of the offending antipsychotic, discontinuing the antipsychotic, or switching to another antipsychotic associated with a lower risk of hyperprolactinemia are first-line management options 2
- Adjunctive aripiprazole is a safe and effective option for lowering prolactin levels within normal limits 2, 3, 4
- Dopamine agonists such as cabergoline and bromocriptine can decrease elevated prolactin levels, with cabergoline being more effective but also associated with a higher risk of cardiac valvular abnormalities 2, 5
- Metformin can cause a mild reduction of prolactin levels, but its use is not well-studied in this context 2
- Herbal supplements have limited data to support their use in antipsychotic-induced hyperprolactinemia 2
Management Considerations
- Management should be tailored to the individual patient, taking into account the severity of symptoms and the patient's medical history 6
- Investigations should include bone mineral density measurements if a patient has been amenorrhoeic for 1 year or more 6
- Estrogen replacement therapy may be considered for hypoestrogenic female patients 6
Efficacy and Safety of Treatment Options
- Adjunctive aripiprazole has been shown to be effective and safe in resolving risperidone-induced hyperprolactinemia, with significant improvements in prolactin levels and menstrual disturbances 3, 4
- Cabergoline treatment has been shown to be safe and effective in reducing risperidone-induced hyperprolactinemia, with significant decreases in plasma prolactin levels and remission of clinical signs 5