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Treatment in Psychiatry   |    
Antipsychotic Treatment in Breast Cancer Patients
Tahir Rahman, M.D.; Charles V. Clevenger, M.D., Ph.D.; Virginia Kaklamani, M.D.; John Lauriello, M.D.; Austin Campbell, Pharm.D.; Kari Malwitz, M.D.; Robert S. Kirkland
Am J Psychiatry 2014;171:616-621. doi:10.1176/appi.ajp.2013.13050650
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Dr. Clevenger has served on an advisory panel for Bristol-Myers Squibb. Dr. Lauriello has received research support from Sunovion, served on monitoring boards for Janssen and Shire, and served on advisory panels and in CME activities for Sunovion and Otsuka. The other authors report no financial relationships with commercial interests.

From the Department of Psychiatry, University of Missouri, Columbia; and the Departments of Pathology and Oncology, Northwestern University, Chicago.

Address correspondence to Dr. Rahman (rahmantahi@health.missouri.edu).

Copyright © 2014 by the American Psychiatric Association

Received May 15, 2013; Revised August 11, 2013; Accepted August 19, 2013.


Special consideration is required when prescribing antipsychotic drugs for patients with an existing diagnosis of breast cancer. The package inserts of all approved antipsychotics contain precautions regarding their administration in this patient group. These drugs are well known to elevate serum prolactin levels to varying degrees. Overexpression of the prolactin receptor is seen in more than 95% of human breast cancers. Many genes that are activated by the prolactin receptor are associated with tumorigenesis and cancer cell proliferation. The authors discuss the pathophysiology, clinical implications, and pertinent preclinical data and make specific recommendations regarding the use of antipsychotics in patients with breast cancer.

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TABLE 1.Effects of Antipsychotics on Prolactin Levelsa
Table Footer Note

a ULN=upper limit of normal. The ULN varied in the studies reviewed, but normal prolactin levels are typically considered to be <20 ng/mL. Data drawn from references 2633.



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