Of all the Second-Generation Antipsychotics (SGAs) risperidone and amisulpride have the highest propensity to elevate prolactin levels. Ziprasidone seems to be less frequently associated with hyperprolactinemia and aripiprazole may even lower prolactin levels. We describe the case of a patient who developed clinically significant hyperprolactinemia while taking both amisulpride and ziprasidone, which resolved with the introduction of aripiprazole

Ms. A a 22- year old woman had a history of paranoid schizophrenia. Two years ago, she was treated with amisulpride 400 mg/day. After 8 weeks of amisulpride treatment, the patient complained of galactorrhea and amenorrhea and her prolactin level was 54 ng/ml. Brain magnetic resonance imaging showed no evidence of a pituitary microadenoma. Two weeks after she stopped taking amisulpride, her prolactin level was 3.8 ng/ml and she menstruated 1 week later. She was given ziprasidone 120 mg/day. Her psychotic symptoms disappeared, but she did not menstruate and her prolactin level rose to 37,4 ng/ml. Ms. A was switched to aripiprazole 10 mg/day.

Only 2 days after the beginning of aripiprazole treatment, the patients prolactin level decreased to 5,6 ng/ml. Her menses resumed with 3 weeks of stopping ziprasidone and remained regular for at least 20 months. Her prolactin level remained normal (the last one was 3,23 ng/ml).

While aripiprazole appears to modulate dopaminergic and serotonergic neurotransmission in a manner similar to that of SGAs, it's partial D2 receptor agonism provides decreased liability for hyperprolactinemia.