Risperidone- and paliperidone-induced hyperprolactinemia in routine clinical practice: demographic and pharmacological determinants from the UAE

Antipsychotic-induced hyperprolactinemia is a common and clinically relevant adverse effect of dopamine D2-blocking agents such as risperidone and paliperidone, yet evidence from Arab populations is scarce. This study explored demographic and pharmacological predictors of hyperprolactinemia in a large UAE cohort. A retrospective cross-sectional study was conducted at the Behavioral Science Institute, Al Ain Hospital, using electronic medical records from 2017 to 2023. Adults (≥18 years) with schizophrenia (Diagnostic and Statistical Manual, fifth edition) treated with risperidone or paliperidone (oral or long-acting injectable) for greater than or equal to 6 weeks before serum prolactin assessment were included. Among 835 patients, the mean age was 40.2 ± 14.0 years; 53.8% were male and 58.4% Emirati. The mean prolactin level was 1126 ± 1334 mIU/l; 61.9% had hyperprolactinemia. The paliperidone-oral group showed the highest mean prolactin (1369 mIU/l; P = 0.003). Sexual side effects occurred in 9.2%. Predictors included younger age, female gender, non-Emirati nationality, paliperidone use, and aripiprazole cotreatment. Hyperprolactinemia was common, particularly among younger females and patients receiving oral paliperidone, and was accompanied by marked under-recognition of sexual side effects. Our study underscores the need for routine endocrine monitoring, rational prescribing to minimize polypharmacy, and region-specific clinical guidelines in the UAE and Gulf region.