From the Research
Normal prolactin levels for patients taking risperidone are typically higher than the general population, commonly ranging from 50-100 ng/mL, with some patients reaching levels of 200 ng/mL or higher, as reported in a 2022 study 1. While normal prolactin levels in non-medicated individuals are generally below 25 ng/mL for women and below 20 ng/mL for men, these elevated levels are considered an expected side effect of risperidone therapy rather than abnormal findings requiring intervention, unless the patient develops symptoms of hyperprolactinemia such as galactorrhea, sexual dysfunction, or menstrual irregularities. Risperidone causes hyperprolactinemia by blocking dopamine D2 receptors in the tuberoinfundibular pathway, which normally inhibits prolactin release from the pituitary gland, as explained in a 2014 review 2. Some key points to consider include:
- Clinicians typically monitor prolactin levels in patients on risperidone but don't necessarily adjust treatment based solely on elevated numbers if the patient remains asymptomatic.
- If problematic symptoms develop, dose reduction, switching to a more prolactin-sparing antipsychotic, or adjunctive treatments might be considered, as suggested in a 2015 study 3.
- The management of hyperprolactinemia should be adapted to the individual patient, taking into account the prolactin level and the presence of symptoms, as recommended in a 2022 review 1.
- Cabergoline is the preferred medication for treatment of hyperprolactinemia, as stated in a 2022 review 4. It's essential to note that the evidence is consistent in indicating that risperidone-induced hyperprolactinemia is a common side effect, and its management should prioritize the patient's quality of life and symptoms, rather than solely focusing on prolactin levels, as emphasized in a 2022 study 1.