Anti-psychotic drugs may be linked to raised diabetes risk

[HA]

Anti-psychotic drugs may be linked to raised diabetes risk in schizophrenia patients

04 Jan 2005
Patients treated with the atypical anti-psychotic agents clozapine and olanzapine may be at an increased risk for insulin resistance, which is a major risk factor for diabetes mellitus, according to a study in the January issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

"Compared with the general population, life expectancy in patients with schizophrenia is shorter by as much as 20 percent, attributable to higher rates of suicide, accidental deaths, and natural causes such as cardiovascular disease, infectious disease, and endocrine disorders," according to background information in the article. "Recently, the newer 'atypical' antipsychotic agents have been linked to several forms of morbidity, including obesity; hyperlipidemia; type 2 diabetes mellitus; and diabetic ketoacidosis [a severe complication of diabetes]."

David C. Henderson, M.D., from Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues, evaluated 36 non-obese outpatients with schizophrenia or schizoaffective disorder who were treated with clozapine, olanzapine, or another medication, risperidone. Participants were given a diet to follow to maintain body weight and were told to fast for 12 hours prior to undergoing a frequently sampled intravenous glucose tolerance test.

"Both nonobese clozapine- and olanzapine-treated groups displayed significant insulin resistance and impairment of glucose effectiveness compared with risperidone-treated subjects," the researchers found.

In conclusion the authors write: "Psychiatrists and primary care professionals should be aware that patients treated with clozapine and olanzapine may be at increased risk for insulin resistance, even if not obese. Insulin resistance is associated with hyperlipidemia, hypertension, and cardiovascular disease and over time may increase the risk for diabetes mellitus in vulnerable individuals. Patients treated with these agents should be routinely screened, counseled to reduce risk, and provided early interventions."


Editor's Note: This study was supported by a grant from the National Institutes of Health General Clinical Research Center, Bethesda, Md.; a Young Investigator Award from the National Alliance for Research of Schizophrenia and Depression, Great Neck, N.Y. (Dr. Henderson); and an Investigator-Initiated Independent Research Grant from Janssen Pharmaceutica, Beerse, Belgium.

Arch Gen Psychiatry. 2005; 62: 19 - 28. Available post-embargo at JAMA Psychiatry – The Science of Mental Health and The Brain

 

[Richardaddy]

I am on olanzapine

This article has really freaked me out. I am on olanzapine, at 5mg a day. What doses of olanzapine were given to these tested patients? They may have been on doses greater than what I am on, it doesn't mean that I will get diabetes does it? I am really worried about being on olanzapine now after reading this article.

 

[David Baxter PhD]

http://www.rxlist.com/cgi/generic/olanzapine_ids.htm

Usual Dose — Olanzapine should be administered on a once-a-day schedule without regard to meals, generally beginning with 5 to 10 mg initially, with a target dose of 10 mg/day within several days. Further dosage adjustments, if indicated, should generally occur at intervals of not less than 1 week, since steady state for olanzapine would not be achieved for approximately 1 week in the typical patient. When dosage adjustments are necessary, dose increments/decrements of 5 mg QD are recommended.

Efficacy in schizophrenia was demonstrated in a dose range of 10 to 15 mg/day in clinical trials. However, doses above 10 mg/day were not demonstrated to be more efficacious than the 10 mg/day dose. An increase to a dose greater than the target dose of 10 mg/day (i.e., to a dose of 15mg/day or greater) is recommended only after clinical assessment. The safety of doses above 20mg/day has not been evaluated in clinical trials.

This is one of those instances where you should be talking to your doctor. He can evaluate your medical status and history as well as family history and determine if you are at risk -- from your other post, I suspect this has already been done but it is probably a good idea for you to satisfy yourself that the doctor has considered this issue in your case. My understanding of the issue is that not all people are at risk but I don't claim to be a physician or pharmacologist.

 

[Daniel E.]

Certainly, eating right (avoiding high-glycemic foods, eating lots of vegetables, etc.) and exercising will lower whatever risk one has for diabetes.

To put things in perspective, imagine you are an obese nursing home patient with type-2 diabetes who is taking Zyprexa. That's a much different situation, and that's one kind of situation that would certainly warrant the medication being switched for another anti-psychotic like Abilify.