Raised prolactin is a common effect of antipsychotics that block dopamine strongly in the pituitary, particularly risperidone, paliperidone and amisulpride, and the first-generation drugs. Its effects — amenorrhoea or irregular periods, galactorrhoea, reduced libido, erectile dysfunction and, over time, lower bone density — are seldom raised by patients themselves and are a frequent unspoken reason for stopping medication.
A direct question at review, and a prolactin level when symptoms are present, is established practice. Where symptoms are troublesome, options include dose reduction, switching to a prolactin-sparing drug, or adding low-dose aripiprazole, chosen with the patient and the stability of their illness in mind.
- Ask directly about periods, breast discharge, libido and erectile function at antipsychotic reviews.
- Check a prolactin level when symptoms are reported, ideally before treatment starts as a baseline.
- Consider a prolactin-sparing drug or adjunctive aripiprazole when symptoms affect adherence.
- Exclude pregnancy and other causes before attributing amenorrhoea to the antipsychotic.
Why it matters
Side effects nobody asks about are a common reason people quietly stop treatment.
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