From the Guidelines
Invega (paliperidone) does not suppress prolactin levels, but rather tends to increase them. This is because Invega, as an atypical antipsychotic, blocks dopamine D2 receptors, and since dopamine normally inhibits prolactin release, blocking these receptors leads to elevated prolactin levels (hyperprolactinemia) 1. The elevation in prolactin is a common side effect of Invega and can cause symptoms such as irregular menstruation, decreased libido, erectile dysfunction, breast enlargement, and breast milk production in both men and women.
Some key points to consider about Invega and prolactin levels include:
- Invega's effect on prolactin is related to its mechanism of action as a dopamine antagonist
- The prolactin elevation with Invega is typically more pronounced than with some other atypical antipsychotics
- If prolactin-related side effects become problematic, a healthcare provider might consider switching to an antipsychotic with less impact on prolactin levels
- Regular monitoring of prolactin levels may be recommended for patients taking Invega, especially if they experience symptoms suggestive of hyperprolactinemia
It's also worth noting that antipsychotic polypharmacy, which may involve the use of Invega in combination with other antipsychotics, has been associated with an increased risk of side effects, including prolactin elevation 1. Therefore, the use of Invega should be carefully considered and monitored, particularly in patients who are at risk for hyperprolactinemia or who are experiencing prolactin-related side effects.
From the Research
Prolactin Levels and Invega (Paliperidone)
- Invega (paliperidone) is associated with increased prolactin levels, as reported in studies 2, 3.
- The use of antipsychotic agents, including paliperidone, has been linked to hyperprolactinemia, which can interfere with reproductive, endocrine, and metabolic systems 2.
- Paliperidone, along with risperidone, is one of the second-generation antipsychotics that can increase prolactin secretion, leading to hyperprolactinemia 2, 3.
Reversal of Paliperidone-Induced Hyperprolactinemia
- Aripiprazole has been shown to reverse paliperidone-induced hyperprolactinemia in clinical cases 4, 5.
- The combination of aripiprazole with paliperidone has been found to decrease prolactin levels in patients with elevated prolactin caused by paliperidone 5.
- The addition of aripiprazole to paliperidone treatment may be a viable option for managing hyperprolactinemia without modifying the antipsychotic regimen 4, 5.
Mechanisms and Effects
- The hyperprolactinemic effects of antipsychotic medication, including paliperidone, are mostly correlated with their affinity for dopamine D2 receptors at the level of the anterior pituitary lactotrophs 3.
- Prolactin-stimulating agents, such as dopamine receptor antagonists, can induce alterations in gonadal function in subjects of either sex 6.
- Direct-acting dopamine receptor agonists, like aripiprazole, can revert impaired gonadal function to normal in patients with hyperprolactinemia 6.