![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Phillipa on March 18, 2014, at 19:41:54
How come? Phillipa
Medscape Medical News from the
American Association for Geriatric Psychiatry (AAGP) 2014 Annual MeetingThis coverage is not sanctioned by, nor a part of, the American Association for Geriatric Psychiatry.
Medscape Medical News > Conference News
Antipsychotic May Boost Gynecomastia Risk
Deborah Brauser
March 17, 2014
ORLANDO, Florida ― The second-generation antipsychotic risperidone (Risperdal, Janssen Pharmaceuticals, Inc) may increase gynecomastia in older men, new research shows.
A review of national health claims data showed that older men who used risperidone or paliperidone (Invega, Janssen Pharmaceuticals, Inc), which is an active metabolite of risperidone, had a significant 69% higher risk of developing the condition than nonusers. Further analyses showed that those who used risperidone also had a higher risk of developing gynecomastia than did users of olanzapine or quetiapine (Seroquel, AstraZeneca Pharmaceuticals LP).
"This is the first and largest epidemiologic study on this question using data from 1 million men in the United States," lead author Mahyar Etminan, PharmD, a drug safety researcher in the Therapeutic Evaluation Unit at Provincial Health Services Authority of British Columbia and an assistant professor at the University of British Columbia, Vancouver, Canada, told Medscape Medical News.
The results were presented here at the American Association for Geriatric Psychiatry (AAGP)
Dr. Mahyar Etminan
"There has been a lot of interest on the risk of gynecosmastia with Risperdal, mainly in adolescent boys but also in older men. There have been reports to the FDA [US Food and Drug Administration] and case reports from academics," said Dr. Etminan.
"So we wanted to see if there was actually a risk with Risperdal that is over and beyond the other antipsychotics. We do know that these drugs in general can cause gynecomastia because of the way they change the hormones in the body. But we weren't really sure whether Risperdal does it more than the others."
The investigators examined information from the IMS LifeLink Health Plan claims database for 1 million men in the United States between the ages of 45 and 80 years who made claims between 2001 and 2011. Within this group, 8285 cases of gynecomastia were identified.
In addition, 10 men who did not have gynecomastia were matched to each man who did have the condition and were included as the control group (n = 82,850). Mean age for both the patients with gynecomastia and the control group was 65.5 years.
Males of All Ages Affected
Results showed that after adjusting for confounding variables, the rate ratio (RR) for gynecomastia was significant at 1.69 (95% confidence interval [CI], 1.05 - 2.72) for current and recent users of risperidone and at 1.69 (95% CI, 1.10 - 2.59) for users of paliperidone when compared with those who did not use either medication.
In addition, there was a trend for a higher risk for the condition for risperidone/paliperidone users when compared with users of quetiapine (RR, 1.41; 95% CI, 0.85 - 2.34) and olanzapine (RR, 1.40; 95% CI, 0.79 - 2.48).
"Statistically, this wasn't significant, which means we didn't have enough power or enough people in this study. But the trend was definitely there," said Dr. Etminan.
Although the current study examined only older men, he cautions that risperidone can also cause this type of adverse event in younger boys ― and recommends that clinicians consider prescribing quetiapine or olanzapine instead to those who need an antipsychotic.
"If everything is the same in terms of efficacy in these antipsychotics, especially for younger men who may have more problems with this psychologically, then I think it may be better to choose something other than risperidone," he said.
Dr. Etiminan admitted that overall, this condition is still pretty rare. "But because we had a million men in our population, we were able to pick it up."
"If you want to put it in perspective, there are millions of prescriptions of Risperdal prescribed. But everything else being equal, then why not prescribe something else if there is a risk for gynecomastia?"
He reported that the study is currently under review for publication in a peer-reviewed journal. In addition, the investigators are starting to collect data to also look at this condition in adolescent boys.
Confirmatory Evidence
"Overall, I didn't think there was anything that new in terms of information. But it was a larger dataset," Iqbal "Ike" Ahmed, MD, clinical professor of psychiatry and geriatric medicine at the University of Hawaii at Manoa, told Medscape Medical News.
Dr. Iqbal Ahmed
"It was fairly consistent with what we already know about Risperdal. Among antipsychotics, it's most likely to cause gynecomastia in some men, probably because of higher prolactin levels. I think it's a confirmatory poster with a larger dataset rather than just clinical experience."
Dr. Ahmed, who was not involved with this research, is also a member of the board of directors for the AAGP and a member of the Scientific Program Committee for the American Psychiatric Association.
He noted that the information is something clinicians should keep in mind, and that they should discuss this potential downside with patients.
"On the one hand, that's a disadvantage compared with another drug. But there might be some other advantages. I think it's just a matter of matching the drug to the patient. But discussing potential risks with patients is always important," said Dr. Ahmed.
The study authors and Dr. Ahmed did not disclose any relevant financial relationships.
American Association for Geriatric Psychiatry (AAGP) 2014 Annual Meeting. Late-Breaker Abstract NR-51. Presented March 15, 2014.
Posted by Lamdage22 on March 19, 2014, at 13:18:01
In reply to Resperidol May Increase Breast Englargement In Men, posted by Phillipa on March 18, 2014, at 19:41:54
Prolactin. Risperdal gave me bitch t*ts. Thats the bodybuilding term for Gyno. Nasty stuff.
And it didnt stop me from thinking the goverment was after me, SO...Im not a fan. Seroquel is the sh*t. Best med ever.
Posted by ed_uk2010 on March 20, 2014, at 4:21:32
In reply to Resperidol May Increase Breast Englargement In Men, posted by Phillipa on March 18, 2014, at 19:41:54
>How come? Phillipa
Risperidone (Risperdal) causes greater elevation of the hormone prolactin than most antipsychotics, but not everyone is affected. Prolactin elevation sometimes causes gynaecomastia. Overall, hyperprolactinaemia is more common in women treated with risperidone than men. Women may experience menstrual disturbances or amenorrhoea and some may start to lactate if prolactin is very high. Both sexes may notice reduced libido. The risk is somewhat dose-dependent. There is a tendency to use lower doses of risperidone than when it was first approved because it is more potent than was first appreciated. In schizophrenia, the usual dose is 2mg to 6mg per day. Side effects are increases at dose above 6mg and efficacy may not be improved.
I don't entirely agree with the 'risperidone can cause gynaecomastia so Rx something else' sentiment in the article. Risperidone works well for some pts. It's one of a number of options available for psychotic disorders. We need a variety of options because pts respond differently.
Olanzapine (Zyprexa) is less likely to elevate prolactin than risperidone but tends to cause more weight gain and metabolic disturbances. Quetiapine (Seroquel) rarely elevates prolactin but it isn't always effective by any means, and many pts discontinue it for this reason... or due to excess drowsiness and dizziness. Aripiprazole (Abilify) actually reduces prolactin but some pts feel nauseated or agitated on it. So, we need options.
Risperidone and paliperidone are also available as depots. Risperidone is given every 2 weeks whereas paliperidone is given every 4 weeks. A lot of people with schizophrenia are too unwell to remember to take tablets, unless they have a lot of social support. Some doctors Rx a small dose of oral Abilify to be taken alongside risperidone/paliperidone depot because it can reduce prolactin back to normal.
Posted by Lamdage22 on March 21, 2014, at 7:00:11
In reply to Re: Resperidol May Increase Breast Englargement In Men, posted by ed_uk2010 on March 20, 2014, at 4:21:32
Im just angry it didnt work when i needed it to.
Posted by bleauberry on March 21, 2014, at 10:41:06
In reply to Resperidol May Increase Breast Englargement In Men, posted by Phillipa on March 18, 2014, at 19:41:54
This is really old news. I can't believe that article has 2014 on it? Where have these people been hibernating?
Blocking certain dopamine receptors causes an extra release of the hormone prolactin, which is responsible for the sexual difficulties and the breast enlargement.
Risperdal and Amisulpride are the most guilty, from what I have seen. Zyprexa and seroquel seem more friendly in terms prolactin side effects.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.