From the FDA Drug Label
Like other drugs that antagonize dopamine D2 receptors, paliperidone elevates prolactin levels and the elevation persists during chronic administration. Paliperidone has a prolactin-elevating effect similar to that seen with risperidone, a drug that is associated with higher levels of prolactin than other antipsychotic drugs Hyperprolactinemia, regardless of etiology, may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotrophin secretion. Laboratory Test Abnormalities ... paliperidone was associated with increases in serum prolactin [see Warnings and Precautions (5. 7)].
Yes, paliperidone can cause high prolactin levels, also known as hyperprolactinemia. This is due to its ability to antagonize dopamine D2 receptors, which can lead to an increase in prolactin levels. This effect is similar to that seen with risperidone, another antipsychotic drug. The elevation in prolactin levels can persist during chronic administration of paliperidone 1.
From the Research
Yes, paliperidone (Invega) can cause hyperprolactinemia, as evidenced by a study published in 2010 2, which reported four cases of female patients who developed hyperprolactinemia after starting treatment with paliperidone. This is a common side effect of paliperidone and other antipsychotic medications, particularly those that block dopamine D2 receptors. The mechanism involves blocking dopamine's inhibitory effect on prolactin secretion in the pituitary gland. When dopamine receptors are blocked, the natural brake on prolactin release is removed, leading to increased prolactin levels in the bloodstream. Some key points to consider include:
- Patients taking paliperidone should be monitored for symptoms of hyperprolactinemia, which may include:
- Menstrual irregularities
- Galactorrhea (inappropriate milk production)
- Sexual dysfunction
- Gynecomastia in men
- Potentially decreased bone mineral density with long-term exposure
- Prolactin levels can rise within days of starting treatment and may persist throughout therapy.
- If problematic hyperprolactinemia occurs, dose reduction or switching to an antipsychotic with lower prolactin-elevating properties might be considered, though this should always be done under medical supervision to maintain psychiatric stability, as discussed in a study published in 2014 3. It's also worth noting that other studies have investigated the treatment of antipsychotic-induced hyperprolactinemia, including the use of dopamine agonists such as cabergoline, as reported in studies published in 2012 4 and 2001 5, and the effects of different antipsychotics on prolactin levels, as discussed in a study published in 2002 6. However, the most relevant and recent evidence for paliperidone-induced hyperprolactinemia is the 2010 study 2.