• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Vitamin B6 Lowers Prolactin on Antipsychotics

Vitamin B6 Lowers Prolactin on Antipsychotics

March 4, 2022
Brian Miller, MD, PhD, MPH.
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Brian Miller, MD, PhD, MPH. Dr. Miller has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

REVIEW OF: Zhuo C et al, Front Psychiatry 2021;12:681418


STUDY TYPE: Randomized, double-blind trial with an active control


Hyperprolactinemia, a common problem on antipsychotics, can cause multiple issues, including sexual dysfunction and gynecomastia. It is a particular problem in treatment-resistant schizophrenia (TRS), as these patients often need higher antipsychotic doses that are more likely to elevate prolactin. Dopamine agonists like bromocriptine can reverse the effect, as can low doses of the dopamine partial agonist aripiprazole (that’s right, this antipsychotic actually treats hyperprolactinemia)—but beyond that, there is limited evidence for other treatment options. Vitamin B6 showed potential in earlier research, and this study tested that treatment in a large controlled trial.


This trial, run in China, tested high-dose vitamin B6 against an active control (low-dose aripiprazole) in 200 men ages 20–40 with TRS and hyperprolactinemia. Patients received either aripiprazole 5 mg twice daily or vitamin B6 300 mg twice daily, in addition to their current antipsychotic, for 16 weeks. Hyperprolactinemia was defined as a prolactin level > 25 µg/L, the usual cutoff for this diagnosis. Prolactin levels, psychotic symptoms, and cognition were assessed at baseline and every four weeks after study initiation. A total of 97% of subjects finished the trial.


Patients randomized to vitamin B6 were much younger, had higher levels of education, and had significantly higher prolactin levels at baseline (95.5 vs 89.1 µg/L) than the aripiprazole group. After 16 weeks, the vitamin B6 group showed a greater reduction in prolactin levels compared to the aripiprazole group (68.1% vs 37.4%). Both groups showed steep reductions in prolactin levels from baseline to week four, but the efficacy of aripiprazole plateaued after week eight, whereas vitamin B6 further reduced prolactin levels through week 16. Also, after 16 weeks, the vitamin B6 group showed a greater reduction in psychotic symptoms (17.8% vs 12.0%) and improvement in cognition (10% vs -5.4%) compared with the aripiprazole group, respectively. Vitamin B6 was well tolerated, with fewer side effects than in the aripiprazole group. Vitamin B6 also had favorable metabolic effects, as it did not increase blood glucose or lipids.


Limitations of the study include the fact that all subjects were male and had TRS. Therefore, the generalizability of findings to other patients and phases of illness is limited.


TCPR’S TAKE
Vitamin B6 may be a viable treatment option for antipsychotic-induced hyperprolactinemia, at least in TRS.

General Psychiatry
KEYWORDS antipsychotics double-blind prolactin randomized-controlled-trial rct schizophrenia vitamin-b6
    Brian Miller, MD, PhD, MPH.

    Aripiprazole-Related Psychotic Exacerbations

    More from this author
    www.thecarlatreport.com
    Issue Date: March 4, 2022
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Living With Mental Illness, TCPR, March 2022
    Mental Illness and Flourishing
    How to Prescribe Omega-3 Fatty Acids
    A Prescription App for Insomnia
    Vitamin B6 Lowers Prolactin on Antipsychotics
    Oral Zuranolone for Postpartum Depression
    A Longer Acting Lorazepam
    DOWNLOAD NOW
    Featured Book
    • MFB6eCover.jpg

      Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

      Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
      READ MORE
    Featured Video
    • therapist_canstockphoto9201097.jpg
      General Psychiatry

      Using SAMe In Clinical Practice with Garrett Rossi, MD

      Read More
    Featured Podcast
    • canstockphoto22709844.jpg
      General Psychiatry

      Psychopharm Commandment #10: Don’t Fear these Meds

      Surprising health benefits of our riskiest meds: Lithium, quetiapine, and clozapine.

      Listen now
    Recommended
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report

    Contact

    info@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.