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Olanzapine-Induced Galactorrhea in a Woman with Psychotic Illness

D. N. Mendhekar, D. Lohia, R. C. Jiloha, Department of Psychiatry, G. B. Pant Hospital, New Delhi, India: Olanzapine typically does not cause significant hyperprolactinaemia due its weaker dopamine binding capacity [1]. Previous reports suggested that olanzapine is a safe and alternative treatment for cases with antipsychoticinduced galactorrhea [2,3]. Contrary to this, we wish to report a case of olanzapine-induced galactorrhea in a woman with psychotic illness. Mrs S, a 33-year-old married woman presented with a 15 day history of suspiciousness, neglecting personal care, remaining withdrawn and showing hallucinatory behaviour. Four years previously, she had a similar psychotic episode which was treated with risperidone (4 mg/day) and haloperidol (5 mg/day), which she continued taking for 1 year. Two years prior to the current presentation, she had a major depressive episode, during which she received lithium 900 mg/day and dothiepin 75 mg/day for 2 months. Her medical history did not reveal any symptom or sign suggestive of endocrinological disorder, including neuroleptic-induced galactorrhea. For the current episode, a diagnosis of schizophreniform disorder (DSM-IV criteria) was made and the patient was started on olanzapine 5 mg/day, which was increased to 20 mg/day, over a period of 4 weeks. At week 5 of therapy, she complained of whitish spontaneous discharge from both breasts, occasionally being so obvious that she had to change her dress. She also had missed her due menstrual period. Her laboratory tests revealed increased serum prolactin level 146.55 ng/ mL (normal range = 1.5–19.0 ng/mL) and normal thyroid function. Her MRI (brain) did not show any evidence of microadenoma. Olanzapine was stopped and was replaced by quetiapine as monotherapy, increasing gradually from 25 mg to 100 mg over a period of 4 weeks. The patient showed complete recovery from symptoms of galactorrhea within 3 weeks after stopping olanzapine. Repeat serum prolactin levels at the second and eighth weeks of quetiapine therapy were 74.47 ng/ mL and 17.32 ng/mL, respectively. For the last 5 months, the patient has been on quetiapine 300 mg/day, with no recurrence of galactorrhea. In view of the temporal correlation between the initiation of olanzapine and onset of galactorrhea, and cessation of galactorrhea subsequent to withdrawl of olanzapine, olanzapine seems to be the only causative agent, rather than low dose quetiapine. We hope our clinical experience with olanzapine stimulates additional systematic clinical trials to reveal the magnitude of such side effects. Of interest is that she did not have galactorrhea on risperidone, an agent well known to be associated with this side effect [4]. We are aware of only one previous case of galactorrhea in a patient on olanzapine, but that patient was also taking divalproex [5].