Treatment of risperidone-induced hyperprolactinemia with a dopamine agonist in children

Background: Risperidone, a potent antagonist of both serotonergic (5HT_2A) and dopaminergic D₂ receptors is associated with hyperprolactinemia in adults and children. Chronically elevated prolactin levels in children with prolactinomas may be associated with arrested growth and development resulting in either delayed puberty or short stature. These possibilities stress the importance of developing a safe and effective approach to drug-induced hyperprolactinemia in youth. We report the successful treatment of risperidone-induced hyperprolactinemia with cabergoline in youth. Methods: We undertook a retrospective case review of four children with risperidone-induced hyperprolactinemia treated with cabergoline. Results: Four males (age 6-11 years) with Diagnostic and Statistical Manual of Mental Disorders (fourth edition) bipolar disorder or psychoses, with risperidone-induced elevations in serum prolactin levels (57.5-129 ng/mL, normal 5-15 ng/mL), were treated with cabergoline (mean dose 2.13 ± 0.09 mg/week). When serum prolactin levels normalized in all four subjects (mean 11.2 ± 10.9 ng/mL), the cabergoline dose was reduced to 1 mg/week in three of four subjects. The mean duration of therapy with cabergoline was 523.5 ± 129.7 days, and the mean duration of therapy with risperidone was 788.5 ± 162.5 days. Cabergoline was well tolerated without adverse effects. Conclusions: Cabergoline may be useful for the treatment of risperidone-induced hyperprolactinemia in youth; however, further research is needed.