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PG CME Table of Contents   
Year : 2009  |  Volume : 51  |  Issue : 1  |  Page : 62-64
Teratogenicity and hyperprolactinemia

Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India

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How to cite this article:
Andrade C. Teratogenicity and hyperprolactinemia. Indian J Psychiatry 2009;51:62-4

How to cite this URL:
Andrade C. Teratogenicity and hyperprolactinemia. Indian J Psychiatry [serial online] 2009 [cited 2021 Sep 24];51:62-4. Available from:

   CME Questions Top

A) Drugs should be prescribed with caution to women of childbearing age because of the risk of teratogenicity, should conception occur during treatment; this concern is particularly important when prescribing drugs that will be required for long periods, such as in the maintenance therapy of epilepsy, bipolar disorders, neuropathic pain, and migraine. Topiramate and valproate are sometimes prescribed as maintenance medications for certain or all of these indications. With this background, mark True or False against each of the following statements:

  1. Topiramate monotherapy is safe during pregnancy.
  2. The use of topiramate along with other antiepileptic drugs is associated with an unacceptably high teratogenic risk.
  3. Valproate is one of the most teratogenic medications used in psychiatry.
  4. The teratogenicity of valproate is substantially higher when the drug is used in combination with other antiepileptic medications.
  5. The teratogenic risk of valproate is dose-dependent.
  6. Valproate is teratogenic only during weeks 6-12 of gestation.
  7. Exposure to valproate during pregnancy can be associated with low IQ in the offspring.

B) Hyperprolactinemia is a common problem with different antipsychotic drugs. Hyperprolactinemia may lead to many adverse consequences, and may thereby jeopardize drug compliance. With this background, mark True or False against each of the following statements:

  1. The normal prolactin level is 25 ng/ml and above.
  2. Hyperprolactinemia may result in increased libido.
  3. Hyperprolactinemia may result in osteoporosis.
  4. Hyperprolactinemia is uncommon with paliperidone.
  5. Aripiprazole augmentation reverses antipsychotic-induced hyperprolactinemia.

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   References Top

1.Ornoy A, Zvi N, Arnon J, Wajnberg R, Shechtman S, Diav-Citrin O. The outcome of pregnancy following topiramate treatment: a study on 52 pregnancies. Reprod Toxicol 2008; 25:388-9.   Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Hunt S, Russell A, Smithson WH, Parsons L, Robertson I, Waddell R, et al . Topiramate in pregnancy: preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology 2008;71:272-6.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Morrow J, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R, et al . Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry 2006;77:193-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Wyszynski DF, Nambisan M, Surve T, Alsdorf RM, Smith CR, Holmes LB, et al . Increased rate of major malformations in offspring exposed to valproate during pregnancy. Neurology 2005;64:961-5.  Back to cited text no. 4    
5.Diav-Citrin O, Shechtman S, Bar-Oz B, Cantrell D, Arnon J, Ornoy A. Pregnancy outcome after in utero exposure to valproate: evidence of dose relationship in teratogenic effect. CNS Drugs 2008;22:325-34.  Back to cited text no. 5  [PUBMED]  
6.Vajda FJ, Hitchcock A, Graham J, Solinas C, O'Brien TJ, Lander CM, et al . Foetal malformations and seizure control: 52 months data of the Australian Pregnancy Registry. Eur J Neurol 2006;13:645-54.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Cunnington M, Tennis P; International Lamotrigine Pregnancy Registry Scientific Advisory Committee. Lamotrigine and the risk of malformations in pregnancy. Neurology 2005;64:955-60.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Bromfield EB, Dworetzky BA, Wyszynski DF, Smith CR, Baldwin EJ, Holmes LB. Valproate teratogenicity and epilepsy syndrome. Epilepsia 2008;49:2122-4.   Back to cited text no. 8    
9.Yonkers KA, Wisner KL, Stowe Z, Leibenlift E, Cohen L, Miller L, et al . Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004;161:608-20.  Back to cited text no. 9    
10.Vinten J, Adab N, Kini U, Gorry J, Gregg J, Baker GA, et al . Neuropsychological effects of exposure to anticonvulsant medication in utero. Neurology 2005;64:949-54.  Back to cited text no. 10    
11.Maguire GA. Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences. J Clin Psychiatry 2002;63:56-62.  Back to cited text no. 11  [PUBMED]  
12.Vekemans M, Delvoye P, L'Hermite M, Robyn C. Serum prolactin levels during the menstrual cycle. J Clin Endocrinol Metab 1977;44:989-93.  Back to cited text no. 12  [PUBMED]  
13.Byerly M, Suppes T, Tran QV, Baker RA. Clinical implications of antipsychotic-induced hyperprolactinemia in patients with schizophrenia spectrum or bipolar spectrum disorders: recent developments and current perspectives. J Clin Psychopharmacol 2007;27:639-61.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.O'Keane V. Antipsychotic-induced hyperprolactinaemia, hypogonadism and osteoporosis in the treatment of schizophrenia. J Psychopharmacol 2008;22:70-5.   Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Meltzer HY, Bobo WV, Nuamah IF, Lane R, Hough D, Kramer M, et al . Efficacy and tolerability of oral paliperidone extended-release tablets in the treatment of acute schizophrenia: pooled data from three 6-week, placebo-controlled studies. J Clin Psychiatry 2008;69:817-29.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Shim JC, Shin JG, Kelly DL, Jung DU, Seo YS, Liu KH, et al . Adjunctive treatment with a dopamine partial agonist, aripiprazole, for antipsychotic-induced hyperprolactinemia: a placebo-controlled trial. Am J Psychiatry 2007;164:1404-10.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]

Correspondence Address:
Chittaranjan Andrade
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5545.44909

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