An Agonist–Antagonist Interaction Model for Prolactin Release Following Risperidone and Paliperidone Treatment

A mechanistic pharmacokinetic/pharmacodynamic model is presented, characterizing the time course of prolactin in healthy as well as schizophrenic subjects following the administration of various doses and formulations of the antipsychotic drugs risperidone and paliperidone. Prolactin concentrations from nine studies (1,462 subjects) were analyzed in NONMEM. A competitive agonist–antagonist interaction model described the competition between these drugs and dopamine for the D2 receptors that regulate prolactin release. Tolerance development was explained by a feedback loop with prolactin stimulating dopamine release, whereas models wherein tolerance is described in terms of depletion of a prolactin pool did not explain the data well. The diurnal prolactin rhythm was described by a two‐period cosine function. Baseline prolactin was health‐status dependent and higher in women than in men, although the drug‐induced release was less than proportional to baseline. This quantitative mechanism‐based model is the first to describe prolactin release in patients, and it confirms that paliperidone and risperidone have similar potencies for prolactin release. Clinical Pharmacology & Therapeutics (2009); 85, 4, 409–417 doi:10.1038/clpt.2008.234