A 24-year-old woman with schizophrenia on risperidone develops secondary amenorrhea and galactorrhea with a serum prolactin of 90 ng/mL. Which antipsychotic would be LEAST likely to worsen her hyperprolactinemia?
- A Amisulpride
- B Aripiprazole ✓
- C Paliperidone
- D Haloperidol
Correct answer: B. Aripiprazole
Explanation
Prolactin secretion is tonically inhibited by hypothalamic dopamine acting on D2 receptors. Risperidone, paliperidone, amisulpride and haloperidol are potent D2 antagonists and commonly cause marked hyperprolactinemia. Aripiprazole is a D2 partial agonist, so it occupies the pituitary D2 receptor while exerting weak intrinsic activity, effectively lowering prolactin, and it is actually used off-label to reverse antipsychotic-induced hyperprolactinemia.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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