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The effects of antipsychotic drug treatment on prolactin concentrations in elderly patients.
J Am Med Dir Assoc. 2003 Jul-Aug; 4(4):189-94.JA

Abstract

OBJECTIVE

To describe the change in serum prolactin concentrations in elderly agitated nursing home patients with dementia who were newly initiated on olanzapine or switched to olanzapine treatment from either conventional antipsychotics or risperidone.

METHODS

During an 8-week open-label olanzapine efficacy trial in elderly nursing home patients demonstrating clinically significant behavioral and psychological symptoms of dementia, serum prolactin concentrations were drawn on four occasions: at time of consent, following a washout period from previous therapy, midway through the study, and at endpoint. To assess post-hoc the effects of prolactin concentrations upon switching to olanzapine treatment, patients were divided into three different groups, based upon status at time of consent: those not taking antipsychotic medication, those taking any conventional antipsychotic, and those taking risperidone. Prolactin concentrations were assessed using a mixed-effect repeated-measures model. Symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Inventory (CMAI), the Clinical Global Impression (CGI)-Severity scale, and the Mini-Mental State Examination (MMSE), and the same repeated measures analysis was performed on these scales.

RESULTS

Patients not on antipsychotic medication at study entry (29 females, 7 males) experienced a significant increase in prolactin concentration baseline to endpoint (P < 0.05) but remained below upper limit of normal for prolactin for both males and females. There was a nonsignificant increase in prolactin concentrations when patients were switched from conventional antipsychotic medications (mean dose 152.41 +/- 192.48 mg/day chlorpromazine equivalents) to olanzapine (2.5 to 10 mg/day) (22 females, 9 males). Patients who entered the study on risperidone (mean dose 1.31 +/- 0.91 mg/day) (13 females, 4 males) experienced a significant decrease in prolactin concentration (P < 0.001). While 62.5% of risperidone-treated patients had above-normal prolactin concentrations at baseline, only 21.4% had above-normal concentrations at endpoint (P = 0.033). Clear correlations between prolactin concentrations and clinical outcomes could not be determined.

CONCLUSION

Consistent with previous findings in younger patients, olanzapine appeared to be a prolactin-sparing antipsychotic medication in the elderly with only modest prolactin increases observed. In addition, patients who were receiving risperidone and then switched to olanzapine experienced a significant reduction in prolactin concentrations that was sustained over the 8-week treatment course with olanzapine. One possible explanation for olanzapine's relatively modest increase in prolactin is that, unlike conventionals or risperidone, olanzapine binds less tightly with the dopamine D(2) receptor.

Authors+Show Affiliations

Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana 46285, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

12837139

Citation

Kinon, Bruce J., et al. "The Effects of Antipsychotic Drug Treatment On Prolactin Concentrations in Elderly Patients." Journal of the American Medical Directors Association, vol. 4, no. 4, 2003, pp. 189-94.
Kinon BJ, Stauffer VL, McGuire HC, et al. The effects of antipsychotic drug treatment on prolactin concentrations in elderly patients. J Am Med Dir Assoc. 2003;4(4):189-94.
Kinon, B. J., Stauffer, V. L., McGuire, H. C., Kaiser, C. J., Dickson, R. A., & Kennedy, J. S. (2003). The effects of antipsychotic drug treatment on prolactin concentrations in elderly patients. Journal of the American Medical Directors Association, 4(4), 189-94.
Kinon BJ, et al. The Effects of Antipsychotic Drug Treatment On Prolactin Concentrations in Elderly Patients. J Am Med Dir Assoc. 2003 Jul-Aug;4(4):189-94. PubMed PMID: 12837139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of antipsychotic drug treatment on prolactin concentrations in elderly patients. AU - Kinon,Bruce J, AU - Stauffer,Virginia L, AU - McGuire,Hillary C, AU - Kaiser,Christopher J, AU - Dickson,Ruth A, AU - Kennedy,John S, PY - 2003/7/3/pubmed PY - 2003/8/21/medline PY - 2003/7/3/entrez SP - 189 EP - 94 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 4 IS - 4 N2 - OBJECTIVE: To describe the change in serum prolactin concentrations in elderly agitated nursing home patients with dementia who were newly initiated on olanzapine or switched to olanzapine treatment from either conventional antipsychotics or risperidone. METHODS: During an 8-week open-label olanzapine efficacy trial in elderly nursing home patients demonstrating clinically significant behavioral and psychological symptoms of dementia, serum prolactin concentrations were drawn on four occasions: at time of consent, following a washout period from previous therapy, midway through the study, and at endpoint. To assess post-hoc the effects of prolactin concentrations upon switching to olanzapine treatment, patients were divided into three different groups, based upon status at time of consent: those not taking antipsychotic medication, those taking any conventional antipsychotic, and those taking risperidone. Prolactin concentrations were assessed using a mixed-effect repeated-measures model. Symptom severity was measured using the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Inventory (CMAI), the Clinical Global Impression (CGI)-Severity scale, and the Mini-Mental State Examination (MMSE), and the same repeated measures analysis was performed on these scales. RESULTS: Patients not on antipsychotic medication at study entry (29 females, 7 males) experienced a significant increase in prolactin concentration baseline to endpoint (P < 0.05) but remained below upper limit of normal for prolactin for both males and females. There was a nonsignificant increase in prolactin concentrations when patients were switched from conventional antipsychotic medications (mean dose 152.41 +/- 192.48 mg/day chlorpromazine equivalents) to olanzapine (2.5 to 10 mg/day) (22 females, 9 males). Patients who entered the study on risperidone (mean dose 1.31 +/- 0.91 mg/day) (13 females, 4 males) experienced a significant decrease in prolactin concentration (P < 0.001). While 62.5% of risperidone-treated patients had above-normal prolactin concentrations at baseline, only 21.4% had above-normal concentrations at endpoint (P = 0.033). Clear correlations between prolactin concentrations and clinical outcomes could not be determined. CONCLUSION: Consistent with previous findings in younger patients, olanzapine appeared to be a prolactin-sparing antipsychotic medication in the elderly with only modest prolactin increases observed. In addition, patients who were receiving risperidone and then switched to olanzapine experienced a significant reduction in prolactin concentrations that was sustained over the 8-week treatment course with olanzapine. One possible explanation for olanzapine's relatively modest increase in prolactin is that, unlike conventionals or risperidone, olanzapine binds less tightly with the dopamine D(2) receptor. SN - 1525-8610 UR - https://www.unboundmedicine.com/medline/citation/12837139/The_effects_of_antipsychotic_drug_treatment_on_prolactin_concentrations_in_elderly_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-8610(04)70344-8 DB - PRIME DP - Unbound Medicine ER -