The Impact of Typical and Atypical Antipsychotics on Prolactin Levels in Adults: A Narrative Review

ABSTRACT Background and aim:Drug-induced hyperprolactinaemia is one of the most common adverse effects of antipsychotic treatment and results primarily from dopamine D₂ receptor blockade within the tuberoinfundibular pathway. This condition may lead to clinically significant consequences, including sexual dysfunction, menstrual disturbances, infertility, and long-term loss of bone mineral density. The aim of this review is to summarise current evidence on the effects of typical and atypical antipsychotics on prolactin levels in adults. Current state of knowledge:First-generation antipsychotics typically cause marked and sustained prolactin elevation. Among second-generation antipsychotics, considerable heterogeneity is observed: risperidone, paliperidone, and amisulpride are associated with substantial prolactin increases, whereas quetiapine and clozapine exert minimal effects. Partial dopamine D₂ agonists, such as aripiprazole, may normalise prolactin levels and represent an effective therapeutic strategy in antipsychotic-induced hyperprolactinaemia. Available evidence also indicates that the prevalence and severity of this adverse effect depend on drug-specific pharmacodynamics, dosage, treatment duration, and individual susceptibility. Conclusions:Selection and modification of antipsychotic therapy should account for the risk of hyperprolactinaemia and its potential long-term consequences. Dose reduction, switching to prolactin-sparing agents, or adjunctive treatment with aripiprazole constitute the main management strategies. Routine prolactin monitoring and consideration of endocrine and reproductive factors are essential elements of personalised psychiatric care. Keywords: Antipsychotic Agents; Hyperprolactinemia; Prolactin; Dopamine Antagonists; Aripiprazole.