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GALACTORRHOEA ASSOCIATED WITH LOW DOSE OLANZAPNE (2

GALACTORRHOEA ASSOCIATED WITH LOW DOSE OLANZAPNE (2.5 mg)

Mishra Ambrish1, Desai Samir N2.

1 Jr. Resident Department of Psychiatry  2Head, Department of Psychiatry

Sri Aurobindo Institute of Medical Sciences, Indore (MP), India

 

Introduction

Olanzapine, an atypical antipsychotic, is not commonly associated with significant hyperprolactinemia due to its weak dopamine binding capacity.[1] Previous reports suggests that olanzapine might be a safe alternative treatment for cases with antipsychotic induced hyperprolactinemia.[2,3] It has a little affect on prolactin lavels and generally regarded to be prolactin sparing although at high dosages hyperprolactinemia may result.[4,5] On the contrary to this we wish to repost a case of olanzapine induces galactorrhoea in a girl with deliberate self Harm (DSH) at low dosage of 2.5 mg/day.

Kywords: Galactorrhoea, Olanzapne

Case Report

An 18 year old girl comes to emergency with deliberate self harm, in the form of wrist slashing. She was managed surgically and was later shifted to our psychiatry ward. No significant past history was suggestive of parenteral deprivation in her early childhood. Personal history revealed difficulties in interpersonal relationship with existing other members in family and impulsive behaviour. Patient was started with carbamazepine and was increased to 400 mg a day over significant period along with daily psychotherapy.

Result After 3-4 weeks of treatment along with psychotherapy, she was augmented with 2.5 mg olanzapine at night because of ideas of reference/erotomanic delusion. This medication continues for another 4-5 weeks, when during the follow-up she complained of some secretions coming from both her breasts. She was also having amenorrhoea. On further evaluations, the secretions were found to be milk. Investigation revealed serum prolactin level to be 189 ng/mL (Normal Range 1.5-19.0 ng/mL). MRI of the brain was done to rule out any evidence of microadenoma. Other hematological tests like CBC, LFT, blood urea, serum creatinine, GTT, T3, T4, TSH, etc. Were done and were within the normal limits. Her pregnancy test was also normal. There was no other significant finding on general physical and systemic examinations. There was no family history of any breast related disorders. There was no history of any sexual activity during the course of treatment.

Olanzapine was stopped for a period of 4 weeks and the serum prolactin levels when repeated was found to me 25 ng/mL. Galactorrhoes was also stopped by the time. Her menstrual cycle also got regularized in next month. She was again on carbamazepine as monotherapy. Her prolactine level after a month was again assessed and was found to be 13 ng/mL.

Conclusion In view of temporal correlation between the initiation of olanzapine and development of galactorrhoea and elevation of prolactin levels and return to normal level n subsequent withdrawal of the drug, olanzapine seems to be likely causative agent. The score on Naranja adverse scale was 6, suggestive a probable relationship with the drug.[6]

Other causes of hyperprolactinemia like pregnancy, thyroid disorders, acromegaly, pituitary mictodenoma and certain breast disorders, etc. Were ruled out on the basis of normal investigations and no abnormal findings on general and systemic examnations.

 

References

1.        Kapur S, Ziprsky R, Shammi C, Sharma CS, Remington G, Seeman P. A positron emission tomography study of quetiapine in schizophrenia: A preliminary finding of antipsychotic effect with transiently high dopamine D2 receptor occupancy. Arch Gen Psychiatry. 2000;57:55-39.

2.        Canuso CM, Hanau M, Jhamb KK, Green AI, Olanzapine use in women with antipsychotic induced hyperprolactinemia. Am J Psychiatry. 1998;155:1458.

3.        Kim KS, Oae CU, Chae JH, Bahk WM, Jun TY, Kim DJ, et al. Effect of olanzapine on prolactin levels of female atients with schizophrenia treated with risperidon. J Clin Psychiatry. 2002;63:408-13.

4.        Crawford AM, Beasley CM, Jr, Tollefson GD. The acute long-term effect on olanzapine compared with placebo and haloperidol on serum prolactin concentrations, Schezophr Res. 1997;26:41-54.

5.        TollefsonGD, Kuntz AJ. Review of recent clinical studies with olanzapine. Br J Psychiatry. 1999;174:30-5.

6.        Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239-45.

7.        Serri O, Chik CL, Ur E, Ezzat S. Diagnosis and Management for Hyperprolactinemia. CMAJ. 2003;169:575-81.