Risperidone and associated amenorrhea: A report of 5 cases

Background We report a 5-case series in which risperidone use in usual or lower-than-usual doses was unexpectedly associated with amenorrhea. Case reports On regimens of risperidone (1-8 mg/day), 5 psychiatric patients with various diagnoses developed amenorrhea with elevated serum prolactin levels (mean = 121.7 ng/mL; range, 61.2-229.8 ng/mL). In 4 of 5 cases, menstruation resumed only when risperidone was withdrawn, and in 1 case, menstruation restarted when the dose was tapered. Follow-up serum prolactin levels dropped to a mean of 17.2 ng/mL (range, 6.4-37.6 ng/mL). Conclusion These findings indicate that the occurrence of amenorrhea during risperidone treatment may be related to elevated serum prolactin levels. This phenomenon may be due either to the dopamine D2 blocking effect of risperidone or to the large individual variability in the rate at which risperidone is metabolized.