Peony-Glycyrrhiza Decoction for Antipsychotic-Related Hyperprolactinemia in Patients with Schizophrenia: A Randomized Controlled Trial

Abstract

Background: Most antipsychotic drugs are dopamine receptor antagonists that usually lead to abnormal increases in prolactin concentrations and the development of hyperprolactinemia (HPRL), which in turn causes sexual dysfunction in patients. Peony-Glycyrrhiza Decoction (PGD) enhanced dopamine D2 receptors (DRD2) and dopamine transporter (DAT) and significantly reversed the expression of DRD2 and DAT. Therefore, we hypothesized that PGD might effectively improve hyperprolactinemia and alleviate sexual dysfunction in patients.

Methods: We performed an 8-week randomized controlled study on 62 subjects with schizophrenia who were randomized into two groups. The experimental group was treated with the PGD intervention, and the control group did not receive treatment. The primary outcome indicators were the levels of sex hormones and the total Arizona Sexual Experience Scale (ASEX) score.

Results: There was a significant difference in PRL levels between the two groups at weeks 4 and 8. From the beginning to the end of the experiment, there was a significant increase in PRL levels in the control group, while there was no significant change in the experimental group. The ASEX scale assessed sexual function in both groups, and patients in the experimental group showed an improvement in sexual function at week 8. During the experiment, the two groups found no differences between Positive and Negative Syndrome Scale (PANSS) scores and Treatment Emergent Symptom Scale (TESS) scores.

Conclusion: PGD significantly improved the patient's sexual function but was less effective in reducing prolactin levels and may prevent further increases in prolactin levels.

Keywords: Peony-Glycyrrhiza Decoction; adverse effects; antipsychotics; hyperprolactinemia; schizophrenia; sexual function.

Figure 1

Liquid chromatogram of PGD sample and mixed standard, (A), Paeoniflorin. (B), Liquiritin. (C), Glycyrrhizic acid.

Figure 2

The changes in prolactin and other sex hormones between the experimental group and the control group during the experiment. Mean levels of PRL (A), FSH (B), LH (C), Estradiol (D), Testosterone (E) and Progesterone (F) in the study group. Error bars represent standard error. The differences between the two treatment groups at each time point were compared by calculating simple effects and obtaining the between-group effects at different times. (**p < 0.01).