Evidence-Based Recommendations for the Pharmacological Treatment of Women with Schizophrenia Spectrum Disorders.
Antipsychotic medication
Estrogen
Prolactin
Raloxifene
Schizophrenia
Sex differences
Journal
Current psychiatry reports
ISSN: 1535-1645
Titre abrégé: Curr Psychiatry Rep
Pays: United States
ID NLM: 100888960
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
accepted:
13
09
2023
medline:
27
11
2023
pubmed:
21
10
2023
entrez:
21
10
2023
Statut:
ppublish
Résumé
Despite clear evidence that sex differences largely impact the efficacy and tolerability of antipsychotic medication, current treatment guidelines for schizophrenia spectrum disorders (SSD) do not differentiate between men and women. This review summarizes the available evidence on strategies that may improve pharmacotherapy for women and provides evidence-based recommendations to optimize treatment for women with schizophrenia. We systematically searched PubMed and Embase for peer-reviewed studies on three topics: (1) sex differences in dose-adjusted antipsychotic serum concentrations, (2) hormonal augmentation therapy with estrogen and estrogen-like compounds to improve symptom severity, and (3) strategies to reduce antipsychotic-induced hyperprolactinemia. Based on three database studies and one RCT, we found higher dose-adjusted concentrations in women compared to men for most antipsychotics. For quetiapine, higher concentrations were specifically found in older women. Based on two recent meta-analyses, both estrogen and raloxifene improved overall symptomatology. Most consistent findings were found for raloxifene augmentation in postmenopausal women. No studies evaluated the effects of estrogenic contraceptives on symptoms. Based on two meta-analyses and one RCT, adjunctive aripiprazole was the best-studied and safest strategy for lowering antipsychotic-induced hyperprolactinemia. Evidence-based recommendations for female-specific pharmacotherapy for SSD consist of (1) female-specific dosing for antipsychotics (guided by therapeutic drug monitoring), (2) hormonal replacement with raloxifene in postmenopausal women, and (3) aripiprazole addition as best evidenced option in case of antipsychotic-induced hyperprolactinemia. Combining these strategies could reduce side effects and improve outcome of women with SSD, which should be confirmed in future longitudinal RCTs.
Identifiants
pubmed: 37864676
doi: 10.1007/s11920-023-01460-6
pii: 10.1007/s11920-023-01460-6
pmc: PMC10654163
doi:
Substances chimiques
Antipsychotic Agents
0
Aripiprazole
82VFR53I78
Raloxifene Hydrochloride
4F86W47BR6
Estrogens
0
Types de publication
Systematic Review
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
723-733Informations de copyright
© 2023. The Author(s).
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