Risperidone is the most prolactin-elevating second-generation antipsychotic, so keep a super low threshold for checking prolactin in patients on it. Aripiprazole can actually lower antipsychotic-induced prolactin, because it binds first, before the other antipsychotics.
Causes and monitoring
Among the second-generation antipsychotics, the most prolactin elevating one is also the most likely to cause EPS, especially at 4 mg and above.
“it's for the second gen antipsychotic, the most prolactin elevating and also the most likely to cause EPS, especially when you're hitting the four milligrams and above”
29:11Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026 Keep a super low threshold for checking a prolactin level in these patients.
“checker prolactin levels, It's super low threshold to check our prolactin level on these patients”
29:42Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026
Lowering it
A partial agonist can actually lower antipsychotic-induced prolactin: even though it is a partial agonist, it binds first, before the other antipsychotics.
“It can actually lower antipsychotic induced prolactin because even though it's a partial agonist, it binds first before the other antipsychotics”
37:11Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026
From these episodes
- Antipsychotic Tier List: Ranking the Best and Worst Anti-psychoticsOct 2026 · 3 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.