Hyperprolactinemia and Galactorrhea Associated with Risperidone-Fluoxetine Combination Therapy: A Case Report

  • Nastaran Kordjazy 113-Aban Drug and Poison Information Center, Tehran University of Medical Sciences, Tehran, Iran. 2Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Kheirollah Gholami 113-Aban Drug and Poison Information Center, Tehran University of Medical Sciences, Tehran, Iran. 2Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
  • Elliyeh Ghadrdan Mail 113-Aban Drug and Poison Information Center, Tehran University of Medical Sciences, Tehran, Iran. 2Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Keywords:
Hyperprolactinemi;, Galactorrhea, Risperidone, Fluoxetine

Abstract

Prolactin is a polypeptide hormone secreted and released by lactotroph cells in the anterior pituitary gland in response to diverse physiological stimuli, principally via the inhibitory action of dopamine and serotonin. This paper describes a 44-year-old woman with depression and obsessive-compulsive disorder (OCD) who called the 13-Aban drug and poison information center (DPIC). She was being treated with fluoxetine (80 mg/day) for 10 months until risperidone was added to her regimen for augmentation therapy (0.5 mg/day). Her symptoms improved within less than two months without significant side effects until she experienced painful bilateral breast discharge along with spotting and menstrual irregularity, besides amenorrhea for the previous 2 cycles and serum prolactin level of 33.7 ng/mL, presenting hyperprolactinemia. After discontinuing risperidone, within two weeks, galactorrhea and breast pain disappeared and amenorrhea resolved. Further prolactin level measurement showed the significant reduction. This neuroendocrine effect observed with very low-dose risperidone plus fluoxetine is apparently exerted through both pharmacokinetic and pharmacodynamic augmentation of this combination therapy.

References

1.Madhusoodanan S, Parida S, Jimenez C. Hyperprolactinemia associated with psychotropics—a review. Hum Psychopharmacol 2010;25(4):281-97.
2. Petit A, Piednoir D, Germain M, Trenque T. Drug-induced hyperprolactinemia: a case-non-case study from the national pharmacovigilance database. Therapie 2003;58(2):159-63.
3. Harris P, Drummond L, Fineberg N. Obsessive‐compulsive disorder: current management options. Prescriber 2019;30(10):14-21.
4. Albert U, Marazziti D, Di Salvo G, Solia F, Rosso G, Maina G. A systematic review of evidence-based treatment strategies for obsessive-compulsive disorder resistant to first-line pharmacotherapy. Curr Med Chem 2018;25(41):5647-61.
5. Dold M, Aigner M, Lanzenberger R, Kasper S. Antipsychotic augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a meta-analysis of double-blind, randomized, placebo-controlled trials. Int J Neuropsychopharmacol 2013;16(3):557-74.
6. Aboraya A, Fullen JE, Ponieman BL, Makela EH, Latocha M. Hyperprolactinemia associated with risperidone: a case report and review of literature. Psychiatry (Edgmont) 2004;1(3):29.
7. Oommen S, Elango P, Alwar M, Solomon S. Adverse Drug Reactions Affiliated with Atypical Antipsychotics in Patients with Schizophrenia. J Young Pharm 2019;11(3):315.
8. Brunelleschi S, Zeppegno P, Risso F, Cattaneo CI, Torre E. Risperidone-associated hyperprolactinemia: evaluation in twenty psychiatric outpatients. Pharmacol Res 2003;48(4):405-9.
9. Torre DL, Falorni A. Pharmacological causes of hyperprolactinemia. Ther Clin Risk Manag 2007;3(5):929-51.
10. Mondal S, Saha I, Das S, Ganguly A, Das D, Tripathi SK. A new logical insight and putative mechanism behind fluoxetine-induced amenorrhea, hyperprolactinemia and galactorrhea in a case series. Ther Adv Psychopharmacol 2013;3(6):322-34.
11. Spina E, Avenoso A, Scordo MG, et al. Inhibition of risperidone metabolism by fluoxetine in patients with schizophrenia: a clinically relevant pharmacokinetic drug interaction. J Clin Psychopharmacol 2002;22(4):419-23.
12. Bondolfi G, Eap C, Bertschy G, Zullino D, Vermeulen A, Baumann P. The effect of fluoxetine on the pharmacokinetics and safety of risperidone in psychotic patients. Pharmacopsychiatry 2002;35(02):50-6.
13. Mannheimer B, von Bahr C, Pettersson H, Eliasson E. Impact of multiple inhibitors or substrates of cytochrome P450 2D6 on plasma risperidone levels in patients on polypharmacy. Ther Drug Monit 2008;30(5):565-9.
14. Benazzi F. Gynecomastia with risperidone-fluoxetine combination. Pharmacopsychiatry. 1999;32(01):41-.
15. Chang SC, Chen CH, Lu ML. Cabergoline-induced psychotic exacerbation in schizophrenic patients. Gen Hosp Psychiatry 2008;30(4):378-80.
16. Kopecek M, Bares M, Horacek J, Mohr P. Low-dose risperidone augmentation of antidepressants or anxiolytics is associated with hyperprolactinemia. Neuro Endocrinol Lett 2006;27(6):803-6.
Published
2020-09-28
How to Cite
1.
Kordjazy N, Gholami K, Ghadrdan E. Hyperprolactinemia and Galactorrhea Associated with Risperidone-Fluoxetine Combination Therapy: A Case Report. J Pharm Care. 8(3):154-156.
Section
Case Report(s)