Which antipsychotic medications cause amenorrhea?

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Pharmacology

Easy

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

Haloperidol is a first-generation (typical) antipsychotic medication.
It causes amenorrhea by blocking dopamine D2 receptors in the brain's tuberoinfundibular pathway.
This dopamine blockade leads to an increase in prolactin levels, a condition called hyperprolactinemia.
Elevated prolactin suppresses the hypothalamic-pituitary-gonadal axis, which inhibits ovulation and causes the absence of menstruation (amenorrhea).

Option B: Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI), which is an antidepressant, not an antipsychotic. While it can cause sexual side effects, it does not typically cause amenorrhea through hyperprolactinemia.
Option C: Sertraline is an SSRI antidepressant, not an antipsychotic. Its most common side effects are gastrointestinal disturbances and sexual dysfunction, not amenorrhea.
Option D: Citalopram is an SSRI antidepressant. It is not an antipsychotic and is not a primary cause of amenorrhea. It is particularly noted for its dose-dependent risk of QT interval prolongation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Endocrine side effects of antipsychotic medications as background academic context rather than a clinical decision trigger.
Nurses must monitor for and ask about menstrual irregularities in female patients taking antipsychotics, as it can be a distressing side effect leading to non-adherence to treatment.
Patient education is crucial. Informing the patient about this potential side effect and encouraging them to report it helps in managing the issue, which may involve dose adjustment or switching medication under the prescriber's guidance.
What if the patient was taking an atypical antipsychotic like olanzapine or quetiapine? The risk of hyperprolactinemia and amenorrhea is generally lower with these agents compared to typicals like haloperidol or the atypical risperidone. However, olanzapine and quetiapine are more associated with metabolic side effects like significant weight gain and hyperglycemia.

How to Approach the Question

First, identify the key terms in the question: 'antipsychotic medication' and 'amenorrhea'.
Next, classify each of the four options by its drug class.
Recognize that Haloperidol is a typical antipsychotic.
Identify that Paroxetine, Sertraline, and Citalopram are all SSRIs, a class of antidepressants.
Since the question specifically asks for an antipsychotic, Haloperidol is the only option that fits this category.
Confirm your answer by recalling that typical antipsychotics are well-known for causing endocrine side effects like hyperprolactinemia, which directly leads to amenorrhea.

Concept Tested & Keywords

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E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 233-235

E6 Medicine Harrison 22e Part 2 p. 1577-1579