Antipsychotic Drugs Linked to Pituitary Tumors

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Antipsychotic Drugs Linked to Pituitary Tumors

http://www.medscape.com/viewarticle/533771?sssdmh=dm1.196438 & src=nldne

Gandey

June 3, 2006 – Treatment with potent D2-receptor antagonists such as

risperidone (Risperdal, Janssen-Ortho) may be associated with pituitary

tumors, researchers say. In the June 2006 issue of Pharmacotherapy, the

team notes that while they haven't uncovered a causal relationship

between the drugs and tumors, clinicians and patients should be aware of

this important adverse effect.

" Atypical antipsychotics are lifesaving medications for a lot of people.

By no means are we advocating that people stop using them — especially

risperidone, " senior author Murali Doraiswamy, MD, a psychiatrist at

Duke University, Durham, North Carolina, told reporters. " But we do need

to learn more about possible differences in their long-term side

effects, and I believe this should be a high priority for investigation. "

Dr. Doraiswamy said that if additional studies confirm the current

findings, stronger warning labels should be considered for these drugs.

His group studied 6 atypical antipsychotics and 1 typical. They used

data from the US Food and Drug Administration's (FDA's) adverse event

reporting system database. With algorithm software, they searched for

disproportionate reporting patterns of pituitary tumors.

Risperidone was linked to 54 (70%) of 77 cases of pituitary tumors

reported in the FDA's database and was followed by haloperidol and

ziprasidone. Risperidone is the most widely prescribed of the atypical

antipsychotics and is generally used to treat schizophrenia and related

psychotic disorders.

Numbers of Reported Adverse Events /b>

Antipsychotic Drug

Pituitary Tumor

Hyperprolactinemia

Galactorrhea

Amenorrhea

Gynecomastia

Risperidone

54

702

530

445

118

Olanzapine

11

37

17

21

23

Haloperidol

9

32

49

24

28

Ziprasidone

6

12

13

2

4

Clozapine

4

15

16

17

7

Quetiapine

1

13

12

3

5

Aripiprazole

0

5

5

2

4

Total*

77

796

630

503

186

*The total is not the sum of the column because a single report may

mention more than one event or more than one antipsychotic drug.

D2-receptor antagonists inhibit dopamine production. A key function of

dopamine is to suppress the release of prolactin, a hormone from the

pituitary gland. Increased cellular production of prolactin can cause

enlargement of the pituitary gland and disrupt production of other

hormones. It can also lead to the development of pituitary tumors.

" The actual numbers of people known to have developed pituitary tumors

as a possible side effect due to any of these medications remains

unclear, because many adverse drug reactions are not reported to the

FDA, " Dr. Doraiswamy adds in a news release. " We also don't have exact

numbers of how many people currently take these drugs. Another caveat is

that pituitary tumors can occur incidentally among the population in

general. "

The researchers are also concerned about children developing pituitary

tumors after the chronic use of antipsychotics. " In this population, we

worry that symptoms may not be evaluated quickly enough, which, if due

to a tumor, could lead to complications such as visual problems or

localized bleeding near the pituitary gland, " Dr. Doraiswamy said.

" Although such serious side effects are quite rare, prescribing

physicians, patients, and their family members should watch for them

because they can be controlled. "

Dr. Doraiswamy pointed out that because antipsychotic medications vary

in their potency, some medications appear to increase prolactin levels

more intensely than others.

While a connection between these drugs and tumors has been suspected for

more than 20 years, this is the first systematic study to document an

association between specific antipsychotic medications and adverse

reports of pituitary tumors in humans, according to the authors.

Pharmacotherapy. 2006;26(6):748-758

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