Question:medium
Which of the following antipsychotics is most associated with increased prolactin secretion?
Which of the following antipsychotics is most associated with increased prolactin secretion?
Show Hint
The most potent D2 blocker among the atypicals raises prolactin the most.
Updated On: Jun 24, 2026
- Olanzapine
- Ziprasidone
- Clozapine
- Risperidone
Show Solution
The Correct Option is D
Solution and Explanation
Step 1: Hyperprolactinemia from antipsychotics tracks with how strongly the drug blocks $D_2$ receptors in the tuberoinfundibular tract.
Step 2: Rank the agents by $D_2$ affinity. Clozapine, olanzapine, and ziprasidone are loose or transient $D_2$ binders and tend to leave prolactin near normal.
Step 3: Risperidone binds $D_2$ tightly and persistently, and it does not readily cross into the brain to spare the pituitary, so circulating prolactin climbs significantly during therapy.
Step 4: Therefore the agent that stands out for raising prolactin is risperidone.
\[\boxed{\text{Risperidone}}\]
Step 2: Rank the agents by $D_2$ affinity. Clozapine, olanzapine, and ziprasidone are loose or transient $D_2$ binders and tend to leave prolactin near normal.
Step 3: Risperidone binds $D_2$ tightly and persistently, and it does not readily cross into the brain to spare the pituitary, so circulating prolactin climbs significantly during therapy.
Step 4: Therefore the agent that stands out for raising prolactin is risperidone.
\[\boxed{\text{Risperidone}}\]
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