Schizophr Res. 2025 Apr 19;280:76-84. doi: 10.1016/j.schres.2025.04.011. Online ahead of print.
ABSTRACT
OBJECTIVES: Antipsychotic-induced hyperprolactinemia is a relevant clinical issue. In this study, we aimed to evaluate the comparative efficacy of adjunctive aripiprazole and metformin in treating antipsychotic-induced hyperprolactinemia among female patients with schizophrenia.
METHODS: A chart review of females diagnosed with schizophrenia and hospitalized from 2010 to 2020, all with antipsychotic-induced hyperprolactinemia and elevated serum prolactin levels. Data included antipsychotic types, baseline and post-intervention prolactin levels. Remission was defined as prolactin levels below 25 ng/dL in females. Cox regression and instrumental variables were used to assess remission hazard ratios at 30, 60, and 180 days.
RESULTS: Among 652 female inpatients (mean age = 38.8 ± 12.7 years; 53.2 % on haloperidol, 17.8 % on risperidone) with hyperprolactinemia (mean baseline prolactin: 69.9 ± 47.8 ng/dL), 366 (56.1 %) received add-on aripiprazole (mean baseline prolactin: 76.5 ± 51.3 ng/dL) and 286 (43.9 %) received metformin (mean baseline prolactin: 61.5 ± 41.6 ng/dL). Aripiprazole was associated with decreased prolactin levels on the 30th day with a remission rate of 73.6 % compared to a 15.0 % remission rate in the metformin group. The effect was significantly greater in the low-dose group (aripiprazole ≤5 mg). Throughout the 180-day follow-up period, the final remission rate was substantially higher in the aripiprazole group than in the metformin group (77.6 % vs 23.1 %). Aripiprazole outperformed metformin in treating hyperprolactinemia induced primarily by haloperidol (remission rate 79.9 %), quetiapine (72.7 %), olanzapine (68.8 %) and risperidone (65.2 %) (all p < 0.01).
CONCLUSIONS: This real-world study suggests that adjunctive aripiprazole therapy effectively reduces prolactin levels in females with antipsychotic-induced hyperprolactinemia. Maximum efficacy is achieved at no >5 mg/day and within 30 days.
PMID:40253894 | DOI:10.1016/j.schres.2025.04.011
