Adjunctive treatment with low-dosage pramipexole for risperidone-associated hyperprolactinemia and sexual dysfunction in a male patient with schizophrenia.

摘要

Patients with schizophrenia receiving treatment with antipsychotics commonly experience sexual dysfunction, which engenders physical and psychological distress and which can influence treatment compliance negatively. However, antipsychotic-associated hyperprolactinemia is known to have profound effects on reproductive health and sexual function, including hypogo-nadism and decreased libido in both sexes, with erectile dysfunction (ED) in men. Generally, 3 strategies have been recommended for treatment of antipsychotic-associated hyperprolactinemia: reducing the existing antipsychotic dosage, substituting another antipsychotic agent for existing medication, or adding a dopamine D_2 receptor agonist such as bromocriptine, amantadine, or cabergoline. However, the utility of an adjunctive dopamine D_2 agonist in managing antipsychotic-associated hyperprolactinemia without worsening psychosis remains controversial. Consequently, another effective and safe management option that can counteract the effects of antipsychotic-associated hyperprolactinemia is anticipated. Pramipexole, a preferential dopamine D_3 receptor agonist, is currently used for treatment of idiopathic Parkinson disease. In addition, pramipexole has been shown to reduce serum prolactin levels in healthy volunteers.