Can quetiapine cause hyperprolactinemia?/nAn 18-year-old woman has during the last year successfull

Fråga: Can quetiapine cause hyperprolactinemia?

An 18-year-old woman has during the last year successfully been treated with quetiapine (Seroquel) 100mgx2 for psychosis. She complains of tender breasts and menstrual disturbance. Her prolactin level is 37 ug/l (<18 ug/l).

Sammanfattning: Quetiapine does not generally cause hyperprolactinemia, although there are a few cases where it might have increased prolactin levels. In the present case other causes of hyperprolactinemia should first be excluded.

Svar: Quetiapine is a newly registered atypic antipshycotic drug with higher affinity for 5HT2-receptors than for D2-receptors (1). Antipsychotics induce hyperprolactinemia by inhibiting D2-receptors on lactotroph cells (2). Since quetiapine has lower affinity for D2- receptors compared to typical antipshycotics it is thought to be less prone to cause hyperprolactinemia (3).

There are some studies published comparing quetiapine with placebo and/or other antipsychotics. No elevations of prolactin levels during quetiapine treatment have been measured in all (3, 4, 5) except one study (6). Temporary elevations of prolactin levels (approximately 40 ug/l in women and 25 ug/l in men) on day one after initiation of quetiapine were measured in this study. After two weeks of treatment prolactin levels were within the normal range. However, published patient data are insufficient for evaluation whether the effect is due to quetiapine or a residual effect of unknown previous antipsychotic treatment (6).

In Drugline a case of galacthorrea during quetiapine treatment has been described. A 17-year-old woman who had switched from risperidone to quetiapine due to galacthorrea still suffered from galathorrea after the change of treatment (7).

In the Swedish adverse drug reactions register there are no cases of hyperprolactinemia due to quetiapine reported. However, quetiapine was approved in Sweden 2003 and since then only nine cases of adverse drug reactions, due to quetiapine, have been reported (8).

In Vigibase, WHO:s adverse drug reactions register, there are 12 cases of hyperprolactinemia and 3 cases of gynecomastia reported due to quetiapine. These reports are not always evaluated as to the cause relationship (9). Fass 2004 Haddad PM, Wieck A. Antipsychotic-induced hyperprolactinaemia. Mechanisms, clinical features and management. Drugs 2004;64(20):2291-2314. Hamner MB, Arvanitis LA, Miller BG, Link CG, Hong WW. Plasma prolactin in schizophrenia subjects treated with seroquel (ICI 204,636). Psychopharmacol Bull 1996;32(1):107-110. Shaw JA, Lewis JE, Pascal S, Sharma RK, Rodriguez RA, et al. A study of quetiapine: efficacy and tolerability in psychotic adolescents. J Child Adolesc Psychopharmacol 2001;11(4):415-24. Atmaca M, Kuloglu M, Tezcan E, Canatan H, Gecici O. Quetiapine is not associated with increase in prolactin secretion in contrast to haloperidol. Arch Med Res 2002;33:562-5. Fric M, Laux G. Plasma prolactin levels and incidence of adverse endocrinologic effects during therapy with atypical neuroleptics. Psychiat Prax 2003;30(Suppl 2):S97-S101. Drugline no 18868 (year 2002) Swedis (cited 2004-11-29) Vigibase (cited 2004-11-29)