抗精神病藥物造成泌乳激素升高及相關症狀

Antipsychotics Induced Hyperprolactinemia and Associated Symptoms

李聖玉(Sheng-Yu Lee) ； 龍佛衛(For-Wey Lung)

《南臺灣醫學雜誌》 2卷1期 (2006/12) Pp. 47-51

https://doi.org/10.6726/MJST.200612_2(1).0010

摘要

高泌乳激素症是使用傳統抗精神病藥物及某些非傳統藥物（如risperidone及amisulpride）常引起的副作用之一，但臨床上常被忽視。有研究顯示高泌乳激素症出現在60%用藥後的女性及40%的男性上。高泌乳激素可能直接影響某些器官或由Hypothalamic pituitary-gonadal axis造成性腺功能低下症。臨床症狀包括性功能障礙、溢乳、月經失調、不孕、骨質疏鬆等，也有報告過體重增加及胰島素敏感性降低的情況。又有研究指出泌乳激素的升高可能與藥物療效及椎體外路徑症狀有關。由此推論，泌乳激素變化造成相當多身體影響，也嚴重影響藥物合作性。但是目前臨床上有關精神病患泌乳激素升高相關的副作用的研究甚少，且多以傳統抗精神病藥物為主，少有針對個別第二代抗精神病藥物對泌乳激素變化及臨床影響的研究。由於第二代抗精神病藥物已在臨床上廣泛使用，本文希望能就傳統及個別第二廣泛使用，本文希望能就傳統及個別第二代抗精神病藥物造成的泌乳激素升高與其臨床相關症狀作整理，了解泌乳激素升高對精神分裂症病患可能造成的各方面影響，如性功能障礙等，期能提醒臨床工作者，並改善病患之服藥合作性及生活品質及基本權利。

關鍵字

抗精神病藥物 ； 高泌乳激素症

並列摘要

Hyperprolactinemia is commonly induced by conventional antipsychotics and certain. However, it received little attention clinically. Recent study revealed approximately 60% of women and 40% of men treated with a prolactin-raising antipsychotic had a prolactin level above the upper limit of the normal range. Some symptoms of hyperprolactinemia result from a direct effect of prolactin on target tissues but others result from hypogonadism caused by prolactin disrupting the normal functioning of the hypothalamic-pituitary-gonadal axis. Common consequences of hyperprolactinemia include sexual dysfunction, galactorrhea, disrupted menstrual cycle, infertility and osteoporosis. In addition, weight gain and insulin insensitivity had been reported as later complication. Past studies point out the association between elevated prolactin levels and treatment efficacy and extra- pyramidal side effects. The side effects associated with high prolactin levels can have a negative effect on patient's treatment adherence. However, correlations between porlactin elevations and clinical symptoms have not been well-established. Most studies to date emphasized on the treatment of traditional antipsychotics. With the increased use of atypical antipsychotics, this paper reviews the published literature regarding prolactin levels in patients with schizophrenia treated with conventional and atypical antipsychotics. It is followed with an overview of the effects of specific atypical antipsychotics on prolactin levels in patients with schizophrenia. This paper serves as a reminder for clinicians that appropriate management should be done to reduce the burden of adverse effects and improve pt's treatment adherence and life quality.

並列關鍵字

antipsychotics ； Hyperprolactinemia