Hyperprolactinemia on Consta (and oral Haldol)

[Psychobabbling]

Got a clinic patient who came to me on Consta and PO Haldol. Been out of the hospital for a few years on this regimen. Pt and mom brought some attention to recent concern for some breast tissue development. Prolactin level is a little elevated (0-17 normal, @ 21.5). Tried cutting back on his Haldol dose by 2.5mg (5 AM/10 qHS) vs. messing with Consta at first. Level increased by an additional 2 pts. No other identified issues besides breast tissue (seems more in the beginning stages, more so around the areola bilaterally, primary saw him and agrees).

So, was going to drop back on his Consta to 37.5. Had been on this regimen for years, resident before me last year apparently tried to make changes without success. He's good with his medications, lives with his mom, so not sure why he got put on Consta to begin with...but anyways....

Since Consta is less bioavailable than oral by 25-30% or so, I'd be reluctant to add oral risperidone if the reduction led to some increase in symptoms. I'd be more inclined to up his Haldol in that case.

Anyone have any recommendations/experience/management suggestions, critiques, etc. How soon would you reschedule follow up? My schedule has been kind of jammed. I was gonna aim for 1-2 weeks. I stay in touch with his mom, so I would hope they would just contact me if he needed to be seen sooner/worse symptoms/etc.

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[nitemagi]

I would try adding abilify and if possible tapering the haldol some.

http://www.ncbi.nlm.nih.gov/pubmed/25981348

 

[F0nzie]

If he responds to PO Abilify you can switch him to monthly Abilify Maintena.

Switching antipsychotics increases risk for symptom recurrence. I would follow q2 weeks.

 

[Psychobabbling]

Cool thanks for the info!