S2E80: Antipsychotic Hyperprolactinemia: A PMHNP Protocol

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode!A step-by-step PMHNP protocol for antipsychotic hyperprolactinemia: who to screen, the 4-lab workup, when to image, and when adding 5 mg aripiprazole works. In this Deep Dive episode, two hosts walk through “Antipsychotic Hyperprolactinemia: A PMHNP Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Risperidone, paliperidone, and older high-potency antipsychotics raise prolactin the most; aripiprazole, brexpiprazole, cariprazine, quetiapine, and clozapine raise it the least. • Most patients will not bring it up. Ask every patient on an antipsychotic about periods, breast discharge, libido, and erections at baseline and at follow-up. • Before you blame the drug, check four things: a repeat prolactin, a pregnancy test, TSH, and kidney function. • Most medication-related elevations stay under about 100 ng/mL. Very high values, headaches, or vision changes call for pituitary imaging and an endocrine consult. • In a 2022 network meta-analysis, adding aripiprazole 5 mg was the only option that reliably lowered prolactin above 100 ng/mL. Recheck in about 4 weeks. • A high number with no symptoms usually does not need treatment, but long-term low estrogen or testosterone can thin bones. Read the full article: https://psychnpfellowship.com/antipsychotic-hyperprolactinemia-pmhnp-protocol-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.