Posted by ed_uk2010 on January 18, 2015, at 9:57:41
In reply to Re: Mutiple mechanism with Zyprexa and some atypicals, posted by Lamdage22 on January 18, 2015, at 9:10:28
> Should i measure my prolactin now as its not elevated by amisulpride yet to be able to compare?
How do you know it's not elevated yet? Even low doses of amisulpride frequently elevate prolactin, and an increase in dose doesn't always elevate it much more. This is because low doses of amisulpride already produce relatively high levels in the pituitary gland, and a further increase in dose (with a correspondingly higher pituitary drug level) may not increase prolactin much further. It doesn't always work like that though - dose increases can produce more hyperprolactinaemia in some cases. Bear in mind that an increase in prolactin doesn't always cause any symptoms. Very large elevations are more likely to cause symptoms but do not always do so, especially in men.
Personally, I wouldn't bother measuring prolactin until you've.... a) been on your final/maintenance dose for several weeks or b) earlier, if symptoms occur. You can have it measured straight away if there are symptoms suggestive of hyperprolactinaemia.
I would not attempt to measure it now as a baseline because you're already on amisulpride ie. it wouldn't actually be a baseline. You can use the 'normal range' as a baseline in future. Assuming you have no symptoms, measuring prolactin now wouldn't tell you a great deal. It's likely to be somewhat above the normal range, but the final effect that amisulpride will have won't be clear yet because you've not been on amisulpride for long at all, and you're not at your final dose. Seroquel and Zyprexa normally only produce small elevations. I think it's fair to assume that your prolactin level before starting amisulpride probably floated around the upper end of the normal range. Prolactin levels do not remain constant, it goes up and down a lot, so one reading doesn't reveal much unless it's extremely high. A couple of readings may need to be taken to get an idea of what effect amisulpride has had, if indeed it has had an effect.
Amisulpride is a bit unusual in frequently producing hyperprolactinaemia even at low doses. Most antipsychotics (except Abilify, clozapine and Seroquel) produce variable but dose-dependent increases. The reason for this is that amisulpride doesn't penetrate the blood brain barrier very well. Subtherapeutic doses still produce high levels outside the BBB, and the D2 receptors of the pituitary are indeed outside the BBB. Therapeutic doses needed to produce adequate levels in the brain produce very high levels peripherally. Peripheral D2 receptors have several function apart from controlling prolactin release. One of their major functions appears to be in the control of the nausea/vomiting reflex and gastric emptying. D2 antagonists are therefore anti-nauseant, reduce gastric reflux, inhibit vomiting (to some extent) and speed up stomach emptying. D2 antagonists used primarily for this purpose include metoclopramide (Reglan, Maxolon) and in some countries, domperidone (Motilium). Levosulpride, similar to amisulpride, is used to treat nausea/vomiting and dyspepsia in some parts of the world, as well as depression and psychosis. Interestingly, Zyprexa appears to be one of the most potent anti-nausea drugs available, and is occasionally used to relieve severe nausea in terminal illness and during cancer chemotherapy when the usual meds have failed. It can be surprisingly effective. Haloperidol (Haldol) is often used in this situation but it's not as reliable. It is, however, inexpensive and less sedating than Zyprexa at the low doses normally used.
In young and middle-aged women, the menstrual cycle can be used as a guide to the significance of raised prolactin. If prolactin is elevated but regular menstruation continues as normal, you can assume that the increased prolactin has not interfered much with other hormones such as oestrogen. This is good to know. If menstruation stops, this is normally because the elevated prolactin has caused mild oestrogen deficiency. Because this predisposes to osteoporosis in the long-term, it's a good idea to check vitamin D levels and to prescribe calcium and vitamin D supplementation where appropriate. Vitamin D deficiency is extremely common, especially in people with a history of mental health problems. Supplementation may help to protect the bones.
poster:ed_uk2010
thread:1074889
URL: http://www.dr-bob.org/babble/20150102/msgs/1075230.html