Hyperprolactinaemia — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisHyperprolactinaemiaMRCPsych Paper B

A 35-year-old woman develops amenorrhoea and galactorrhoea after starting an atypical antipsychotic. Her serum prolactin is 3200 mU/L, and other causes of hyperprolactinaemia have been excluded. Which antipsychotic is most strongly associated with this adverse effect?

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Correct answer: E — Risperidone

Risperidone is the best answer. It is strongly associated with clinically significant hyperprolactinaemia through dopamine D2-receptor antagonism in the tuberoinfundibular pathway. Raised prolactin suppresses hypothalamic GnRH and may cause amenorrhoea, anovulation, infertility and galactorrhoea. Haloperidol can also markedly elevate prolactin but is a first-generation antipsychotic, whereas the stem specifies an atypical antipsychotic. Olanzapine and lurasidone may increase prolactin, but generally have a less pronounced association than risperidone. Aripiprazole is a D2 partial agonist and is usually prolactin-sparing; it may be used to reduce hyperprolactinaemia caused by another antipsychotic. In clinical practice, marked or symptomatic elevation still requires assessment for pregnancy, endocrine disease, renal impairment, other medicines and pituitary pathology.

Reference: Electronic Medicines Compendium. Risperidone 2 mg Tablets, Summary of Product Characteristics, sections 4.4, 4.6 and 4.8; updated 17 January 2024. https://www.medicines.org.uk/emc/product/11872/smpc