Drug-Induced Hyperprolactinaemia — RACP Adult Medicine MCQ

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ModerateClinical PharmacologyDrug-Induced HyperprolactinaemiaRACP Adult Medicine

A 32-year-old woman presents with cyclical breast tenderness, galactorrhoea, and amenorrhoea. Her prolactin is 3,800 mU/L (mildly elevated). She is on risperidone 4 mg daily for schizophrenia. MRI pituitary is normal. What is the most appropriate management?

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Correct answer: D — Switch risperidone to aripiprazole (partial dopamine agonist)

Drug-induced hyperprolactinaemia is the most common cause of elevated prolactin. All typical antipsychotics and most atypical antipsychotics (especially risperidone and paliperidone) raise prolactin by blocking D2 receptors in the tuberoinfundibular pathway. Aripiprazole (a partial D2 agonist) has the lowest impact on prolactin and may even lower it. Switching to aripiprazole (in consultation with the patient's psychiatrist) addresses both the hyperprolactinaemia and the underlying psychiatric condition. Adding cabergoline while continuing risperidone is not recommended.

Reference: eTG – 2025 – Psychotropic; AMH – 2025 – Antipsychotics