Pharmacological Aspect and Challenges in Managing Amisulpride- Induced Hyperprolactinemia: A Case Report and Implications of Failed Normalization with Add-On Aripiprazole and the Risk of Mastitis

Amisulpride引起之高泌乳激素血症處置之藥理學觀點與挑戰：Aripiprazole附加療法失效且合併感染風險之個案報告與啟示

目的
高泌乳激素血症是抗精神病藥物的不良反應之一，原理是阻斷腦下垂體體後葉的多巴胺D2受體。根據先前研究，添加Aripiprazole可有效降低非典型抗精神病藥物引起的高泌乳素血症，因為Aripiprazole是D2受體部分致效劑。然而，我們報告了一例使用Aripiprazole卻無法降低Amisulpride引起之高泌乳激素血症的個案。
方法
作者將描述一例因抗精神病藥物引起的高泌乳激素血症而導致乳腺炎的案例，並說明添加Aripiprazole應用在調節高泌乳激素方面的原理。此外，我們還會從藥理學理論的角度討論添加Aripiprazole但未能降低本案泌乳激素的失敗原因。
結果
由於藥物親脂性之不同，造成Amisulpride和Aripiprazole對腦下垂體D2受體的親和力不同，兩藥的藥理學上的差異解釋了Aripiprazole無法調節Amisulpride引起之高泌乳激素血症的原因。
結論
此個案向醫療專業人員提供了一個重要的暗示，即抗精神病藥物的高泌乳激素副作用可能導致乳腺感染風險。在使用Amisulpride時，需要定期檢查泌乳激素血中濃度，特別是在停經後的婦女與男性。也因此，遇到不尋常的感染時，跨團隊的共同照護需特別提倡，及早的識別並處理Amisulpride引起的升高泌乳素血症對於預防進一步副作用非常重要。

Purposes
Hyperprolactinemia is a known adverse effect of antipsychotics, attributed to the blockade of dopamine D2 receptors in the posterior pituitary. While previous studies have shown the potential of add-on aripiprazole, a partial agonist of D2 receptors, to reduce atypical antipsychotic-induced hyperprolactinemia, this case report presents an instance where aripiprazole failed to alleviate amisulpride-induced hyperprolactinemia.
Methods
The case report describes a patient who developed mastitis attributed to hyperprolactinemia secondary to the use of antipsychotics, specifically amisulpride. The authors demonstrate the principles of using add-on aripiprazole to manage elevated prolactin levels. Furthermore, the article will discuss the reasons for the failure of aripiprazole to lower prolactin when combined with amisulpride from a pharmacological perspective.
Results
The difference in lipophilicity between amisulpride and aripiprazole is identified as a contributing factor to the varying affinities for dopamine D2 receptors in the pituitary. This pharmacological distinction elucidates the inability of aripiprazole to regulate amisulpride-induced hyperprolactinemia.
Conclusions
This case highlights the paramount importance for healthcare professionals to remain vigilant regarding the risk of mastitis resulting from antipsychotic side effects. Regular monitoring of blood prolactin levels is crucial for patients on amisulpiride, particularly men and menopausal women. Furthermore, adopting a multidisciplinary team approach is essential for managing uncommon infections. Early identification and intervention of elevated prolactin levels induced by amisulpiride play a pivotal role in preventing further side effects.