Atypical Antipsychotic-induced Type 2 Diabetes
Atypical Antipsychotic-Induced Type 2 Diabetes Jennifer Berg, PharmD, Gregory Stajich, PharmD, and Martin Zdanowicz, PharmD Patients with schizophrenia and other disorders who take atypical antipsychotics should be monitored for an increased risk for diabetes. Reducing the Risk for Metabolic Disorders Begins with Choosing the Right Treatment Patients taking antipsychotic agents, and particularly those with schizophrenia, are at risk for developing more detrimental conditions that can lead to increased susceptibility to cardiovascular disease and hyperlipidemia. Since 2002, coinciding with the addition of the newer generation of atypical antipsychotic drugs, patients have also been prone to an increase in weight gain and the subsequent metabolic effects leading to a predilection to type 2 diabetes. According to the National Institute of Mental Health, in 2008, 2.4 million people in the United States were living with schizophrenia.1 Schizophrenia is a mental disorder characterized by positive symptoms like delusions, hallucinations, and disorganization of thought, and negative symptoms such as flat affect, avolition, alogia, anhedonia, and social inattention.2,3 In addition to the mental complications of the disorder, studies have shown that patients with schizophrenia are 2 to 3 times more likely to develop type 2 diabetes.4 There is not a clear understanding why schizophrenic patients are at an increased risk for developing type 2 diabetes. Schizophrenic patients have a number of risk factors for type 2 diabetes, including family history, increased body mass index (BMI), sedentary lifestyle associated with the disorder, and the use of atypical antipsychotic medications.5 In 2004, the FDA required that a warning be placed in the package inserts of all atypical antipsych Continue reading >>
Can Olanzapine Make You Diabetic?
Olanzapine is an atypical antipsychotic that has been widely used because of its better clinical efficacy, superior activity against negative symptoms, lesser extra-pyramidal symptoms, and better tolerability profile compared to typical antipsychotics. Recently, a flurry of reports have stated that olanzapine is associated with high blood sugar levels in new onset or pre-existing diabetes mellitus and ketoacidosis, which may be reversible after discontinuation of olanzapine. The exact cause of glucose dysregulation by olanzapine is not clear. It has been hypothesized that 5-HT1 antagonism may decrease the responsiveness of the pancreatic beta cells, thus reducing the secretion of insulin and causing hyperglycemia. In vivo studies suggest that olanzapine impairs glycogen synthesis via inhibition of the classical insulin signaling cascade and this inhibitory effect may lead to the induction of insulin resistance in olanzapine-treated patients. Since olanzapine is becoming more and more popular as a first line agent in the treatment of psychosis as well as in mood disorders, proper guidelines have to be established for monitoring blood glucose levels and determination of risk factors for diabetes mellitus. Hence, it is very important for clinicians that all patients started on olanzapine require regular monitoring of their blood sugar levels. Clinicians should take at most precaution in pre-existing diabetic patients before starting olanzapine. If olanzapine is suspected to being a causal factor for hyperglycemia, we can reduce that risk by withdrawal of olanzapine or switching over to some other medicines without worsening the psychiatric condition of patient. India being a diabetes rich country; the author strongly suggests at least a baseline survey should be undertaken Continue reading >>
Hyperglycemia Associated With Olanzapine Treatment
Sir, Olanzapine is an atypical antipsychotic that has been widely used because of its better clinical efficacy, superior activity against negative symptoms, lesser extra-pyramidal symptoms, and better tolerability profile compared to typical antipsychotics. Recently, a flurry of reports have stated that olanzapine is associated with high blood sugar levels in new onset or pre-existing diabetes mellitus and ketoacidosis,[1–4] which may be reversible after discontinuation of olanzapine. The exact cause of glucose dysregulation by olanzapine is not clear. It has been hypothesized that 5-HT1 antagonism may decrease the responsiveness of the pancreatic beta cells, thus reducing the secretion of insulin and causing hyperglycemia.[5] In vivo studies suggest that olanzapine impairs glycogen synthesis via inhibition of the classical insulin signaling cascade and this inhibitory effect may lead to the induction of insulin resistance in olanzapine-treated patients. Koller and Doraiswamy[6] reported 188 new-onset diabetes out of 237 cases, which had no previous history of diabetes mellitus. Olanzapine can cause fatal outcome like diabetic ketoacidosis that may lead to death. Same authors reported 23 deaths among 289 cases of hyperglycemia. Similarly, Spivak et al[7] reported a case where patient had higher blood sugar level but after discontinuation of olanzapine it became normal. Bechara and Goldman-Levine[8] and Ober et al[9] reported similar cases where treatment with olanzapine had worsened the clinical condition in patients with a history of diabetes mellitus. We report four cases of hyperglycemia in schizophrenic patients after starting olanzepine and sugar values returned to normal after changing the medication. A 54-year-old male with no past or family history of diabetes Continue reading >>
Tips From Other Journals - American Family Physician
Increased Risk of Diabetes with Olanzapine Therapy New antipsychotic medications such as olanzapine and risperidone often can effectively control schizophrenic symptoms without the extrapyramidal side effects of traditional agents. However, these newer medications are associated with metabolic changes, such as weight gain, dyslipidemia, and even cardiomyopathy, which could cause significant morbidity. Koro and colleagues studied the risk of diabetes in patients taking olanzapine and risperidone. The authors used data from the General Practice Research Database, which involved more than 400 practices in England and Wales with more than 30 million patient-years of observations. Case patients were defined as persons being treated for schizophrenia who developed diabetes within three months of the start of the study period. All new cases were verified by a search of medical records for any diagnosis of diabetes or prescription for insulin or an oral hypoglycemic agent. For each case patient, they matched six control patients by age, sex, and length of observation. All control patients were diagnosed with or being treated for schizophrenia but had no diagnosis of diabetes or record of diabetic therapy. Of 19,637 patients being treated for schizophrenia, 451 patients with new cases of diabetes were matched with 2,696 control patients. The study population consisted of equal numbers of men and women, and the average age of participants was 51 years. Olanzapine was prescribed for 970 patients (4.9 percent) and risperidone for 1,683 patients (8.6 percent). During the follow-up period (mean, 5.2 years), 451 patients developed diabetes. The incidence of diabetes in all patients with schizophrenia who were treated with antipsychotics was 4.4 per 1,000 person-years, but it was sign Continue reading >>
Lilly Adds Strong Warning Label To Zyprexa, A Schizophrenia Drug
Business Day |Lilly Adds Strong Warning Label to Zyprexa, a Schizophrenia Drug Eli Lilly yesterday added strong warnings to the label of Zyprexa, its best-selling medicine for schizophrenia , citing the drugs tendency to cause weight gain, high blood sugar, high cholesterol and other metabolic problems. For the first time, Zyprexas label now acknowledges that the drug causes high blood sugar more than some other medicines for schizophrenia and bipolar disorder , called atypical antipsychotics. Lilly previously argued that Zyprexa had not been proved to cause high blood sugar at a more frequent rate than its competitors. Concern about Zyprexas side effects has been increasing since at least 2004, and Zyprexas prescriptions and market share have fallen sharply over the period. As a result, the new warnings may have only a moderate impact among doctors and patients, said S. Nassir Ghaemi, director of the Bipolar Disorder Research Program at Emory University. The new label will also indicate that patients who take Zyprexa may keep gaining weight for as long as two years after starting therapy. That contradicts earlier public statements by Lilly that weight gain on Zyprexa tends to plateau after a few months of use. One in six patients who take Zyprexa will gain more than 33 pounds after two years of use, the label says. Weight gain and high blood sugar are risk factors for diabetes , although Lilly says there has been no proof that Zyprexa causes diabetes more than its competitors do. Obviously, we know that weight gain is a known risk factor for diabetes, said Marni Lemons, a Lilly spokeswoman. However, not all patients who gain weight develop diabetes. Ms. Lemons also noted that older antipsychotic medicines also have severe side effects, including a tendency to cause fa Continue reading >>
Zyprexa And Diabetes
Zyprexa (olanzapine) is an atypical antipsychotic used to treat emotional and neurologic conditions such as bipolar disorder and schizophrenia. Like any other medication, Zyprexa is not free of side effects. Aside from bothersome reactions, this medication can also cause a few side effects that should be taken seriously. Diabetes is one of these. Studies show that atypical antipsychotic medications, including Zyprexa, may increase the risk of diabetes. These medications can also worsen preexisting diabetes. Clinical studies show that between 1 in every 100 and 1 in every 1,000 users of Zyprexa developed diabetes. Post-marketing studies have shown several cases of abnormally high blood sugar (hyperglycemia) which has even led to coma or death. How Zyprexa causes diabetes is not entirely clear although there are several factors that can probably contribute to the development of diabetes in patients taking Zyprexa. Some studies suggest that people with schizophrenia are generally at increased risk of developing diabetes, regardless of the medication they currently take. The average diet and lifestyle of these patients put them at increased the risk of diabetes. It is also thought that the biochemical changes caused by atypical antipsychotic medications predispose users to diabetes. Zyprexa may have direct effects on the bodys insulin production, though the exact mechanism remains unknown. Perhaps, this is also the reason behind weight gain caused by Zyprexa . A recent study also shows that young children and adolescents using Zyprexa are at higher risk of developing diabetes and weight gain. These factors all contribute to the incidence of diabetes among patients using Zyprexa. For people with undiagnosed diabetes, Zyprexa can worsen the condition. Patients who are at hig Continue reading >>
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Patients On Atypical Antipsychotic Drugs
Patients with schizophrenia are more likely than the general population to develop diabetes, which contributes to a high risk of cardiovascular complications; individuals with schizophrenia are two to three times more likely to die from cardiovascular disease than the general population. The risk of diabetes, and hence cardiovascular disease, is particularly increased by some of the new atypical antipsychotic drugs. Individuals taking an atypical antipsychotic drug, particularly younger patients under 40 years of age (odds ratio 1.63, 95% CI 1.23–2.16), represent an underrecognized group at high risk of type 2 diabetes. The mechanisms responsible for antipsychotic-induced diabetes remain unclear. Hypotheses include these drugs’ potential to cause weight gain, possibly through antagonism at the H1, 5-HT2A, or 5-HT2C receptors. Other mechanisms independent of weight gain lead to elevation of serum leptin and insulin resistance. Patients with psychoses have difficulties with diet and lifestyle interventions for diabetes and weight management. If hyperglycemia develops, withdrawal from antipsychotic medication will often be inappropriate, and a change to an atypical antipsychotic drug with lower diabetogenic potential should be considered, especially in younger patients. Management of psychoses should routinely include body weight and blood glucose monitoring and steps to promote exercise and minimize weight gain. Careful collaboration between the psychiatric and diabetology teams is essential to minimize the risk of diabetes in patients taking atypical antipsychotic medication and for effective management when it develops. This collaboration will also help minimize the already high risk of cardiovascular disease in individuals with schizophrenia. IS THERE A LINK BETWEE Continue reading >>
Diabetes And Antipsychotic Drugs
Aust Prescr 2004;27:118-91 Oct 2004DOI: 10.18773/austprescr.2004.098 There is an increased risk of diabetes in patients with schizophrenia and this risk is elevated by some antipsychotic medications. The risk is greater with the atypical drugs clozapine and olanzapine and the low potency conventional antipsychotics than with risperidone or high potency conventional drugs. While weight gain may be a mechanism for the development of diabetes, a direct effect of these drugs on insulin action in muscle may also be an important contributor. Patients with major psychosis should be managed in the same way as other patients with diabetes, but difficulties in complying with diet, exercise and taking medication should be kept in mind. Treating cardiovascular risk factors is important. An impaired action of insulin (insulin resistance) in patients with schizophrenia was reported over 55 years ago and later confirmed in Australia. 1 The prevalence of diabetes in patients with schizophrenia was found to be higher than in the general population even before the widespread use of antipsychotic medication. The mechanisms underlying the relationship between schizophrenia and diabetes remain unknown. It is now clear that some antipsychotic medications increase the risk of diabetes in patients with schizophrenia. Rarely, this may present as diabetic ketoacidosis. The atypical medications (Table 1) have become widely used because of their lower rate of extra pyramidal adverse effects compared to older classes of medication such as the phenothiazines and the butyrophenones. However, while some of the atypical drugs are better tolerated, they also increase the incidence of diabetes. In patients younger than 40 years of age, the odds ratio for developing diabetes is 1.63 if they are taking an Continue reading >>
Which Atypical Antipsychotics Carry The Highest Risk For Diabetes?
Which Atypical Antipsychotics Carry the Highest Risk for Diabetes? If you are unfamiliar with antipsychotics, my article, Psychosis 101 , has a detailed description of the medications and how they work. The following information on diabetes risk in antipsychotic medications comes from two papers from the Journal of Clinical Psychiatry: Antipsychotic Medications: Metabolic and Cardiovascular Risk by Dr. John W. Newcomer and Switching Antipsychotics as a Treatment Strategy for Antipsychotic-Induced Weight Gain by Dr. Peter J. Weiden. Both researchers show conclusive evidence that the risk of diabetes from certain antipsychotics is high and must be addressed immediately within the entire healthcare community. There are six atypical antipsychotics in use today: (a newer antipsychotic called Saphris was not a part of the metabolic syndrome studies cited in the article.) Numerous and well-documented studies have shown a serious and potentially dangerous connection between certain second generation antipsychotics and the risk of diabetes because of their connection to metabolic syndrome. Those atypical antipsychotics with the highest risk for developing diabetes are: In a major NIMH study (the CATIE project), Zyprexa was associated with relatively severe metabolic effects. Subjects taking Zyprexa showed a major weight gain problem and increases in glucose, cholesterol, and triglycerides. The average weight gain over the 18-month study period was 44 pounds. Abilify and Geodon do not have a significant risk of metabolic syndrome and thus are not considered a diabetes risk (although the FDA has ordered all makers of antipsychotic drugs to include a warning about a possible link with diabetes on their product label). The term high-risk antipsychotics used throughout this article Continue reading >>
Olanzapine - Wikipedia
Urine (57%; 7% as unchanged drug), faeces (30%) [3] [4] Olanzapine (originally branded Zyprexa) is an antipsychotic medication used to treat schizophrenia and bipolar disorder . It is usually classed with the atypical antipsychotics , the newer generation of antipsychotics. [5] It appears to have slightly greater effectiveness in treating schizophrenia (especially the negative symptoms ) and a lower risk of causing movement disorders than typical antipsychotics . [6] Olanzapine, however, has a higher risk of causing metabolic side effects like weight gain and type 2 diabetes than the typical antipsychotics. [5] [6] Olanzapine is believed to work by blocking, or antagonizing, the dopamine D2 receptor , an effect it shares with most antipsychotics. [7] Like most other atypical antipsychotics, olanzapine also strongly antagonizes the 5-HT2A receptor , which may partially underpin its reduced propensity for causing movement disorders. [7] Olanzapine was first patented in 1971. [8] The drug became generic in 2011. Sales of Zyprexa in 2008 were $2.2 billion in the US , and $4.7 billion worldwide. [9] The first-line psychiatric treatment for schizophrenia is antipsychotic medication; olanzapine is one such medication. [10] Olanzapine appears to be effective in reducing symptoms of schizophrenia, treating acute exacerbations, and treating early-onset schizophrenia. [6] [11] [12] [13] The usefulness of maintenance therapy, however, is difficult to determine as more than half of people in trials quit before the six-week completion date. [14] Treatment with olanzapine (like clozapine ) may result in increased weight gain and increased glucose and cholesterol levels when compared to most other second-generation antipsychotic drugs used to treat schizophrenia. [15] [11] National In Continue reading >>
What Is The Percentage Of People Who Get Diabetes While Taking Zyprexa?
Home Q & A Questions What is the percentage of... What is the percentage of people who get Diabetes while taking Zyprexa? lamictal , zyprexa , depression , bipolar disorder , anxiety , benzodiazepine withdrawal , insomnia , obsessive compulsive disorder , panic disorder , restless legs syndrome , periodic limb movement disorder , clonazepam , hydroxyzine , fear My doctor has just started me on 10 mg of Zyprexa and my biggest fear is getting Diabetes. I am Bi Polar and also take 100 mg Lamictal .5 mg Clonazepam 25 mg Hydroxyzine Pamoate. I am 65 years old and have been diaganosed with Bi Polar II at age 45. Since then I have been struggling with finding the right medication for my depression. While Zyprexa is considered safer than its predecessors like Haldol, it still has side effects that you need to be aware of. The extensive info that I found includes the following: Physicians should consider the risks and benefits when prescribing olanzapine to patients with an established diagnosis of diabetes mellitus, or having borderline increased blood glucose level (fasting 100-126 mg/dL, non-fasting 140-200 mg/dL). Patients taking olanzapine should be monitored regularly for worsening of glucose control. Patients starting treatment with olanzapine should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continu Continue reading >>
Keeping Blood Sugar Under Control While On Zyprexa...
Keeping blood sugar under control while on Zyprexa... Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Keeping blood sugar under control while on Zyprexa... I know I have another thread on Zyprexa but I figure these issues are separate entities. What can I do to help monitor my blood sugar while on Zyprexa so I don't get the spikes so that I may not get the high blood sugar that comes with taking the medication? I ask because I'm already predisposed due to family history and if I can monitor my blood sugar, I might have a good fighting chance. You can get a blood glucose monitor and test your blood glucose, after meals. But what will you do if your blood gluose goes up? You could stop taking Zyprexa, but you may find that the the high blood glucose stays. Stopping Zyprexa when blood glucose is high is a bit like shutting the door after the horse has bolted. It makes more sense to find an alternative medication that doesn't cause insulin resistance, and to do that now. Makes since, but I've tried other medications and they weren't as helpful. I've tried Depakote and they couldn't stabilize the blood levels, and I'm already on another mood stablizer (Topamax). It's just unfortunately not enough to control the mood swings anymore. That's part of the reason I'm on Zyprexa. I also take it for visual hallucinations. I tend to see bugs on the floor for example or spiders on the walls, or I see things/people walking past my peripheral vision and there's nothing there. So, I know I need some form of antipsychotic medication to help control something like that. I spoke to my doctor a long time ago about how often the tests are done on her part for th Continue reading >>
Diabetes Risk Associated With Use Of Olanzapine, Quetiapine, And Risperidone In Veterans Health Administration Patients With Schizophrenia
Diabetes Risk Associated with Use of Olanzapine, Quetiapine, and Risperidone in Veterans Health Administration Patients with Schizophrenia Correspondence to Dr. Bruce L. Lambert, Department of Pharmacy Administration, University of Illinois at Chicago, 833 South Wood Street (M/C 871), Chicago, IL 60612-7231 (e-mail: [email protected] ). Search for other works by this author on: American Journal of Epidemiology, Volume 164, Issue 7, 1 October 2006, Pages 672681, Bruce L. Lambert, Francesca E. Cunningham, Donald R. Miller, Gregory W. Dalack, Kwan Hur; Diabetes Risk Associated with Use of Olanzapine, Quetiapine, and Risperidone in Veterans Health Administration Patients with Schizophrenia, American Journal of Epidemiology, Volume 164, Issue 7, 1 October 2006, Pages 672681, To evaluate risk of new-onset type 2 diabetes associated with use of selected antipsychotic agents, the authors conducted a new-user cohort study in a national sample of US Veterans Health Administration patients with schizophrenia (and no preexisting diabetes). The authors studied 15,767 patients who initiated use of olanzapine, risperidone, quetiapine, or haloperidol in 19992001 after at least 3 months with no antipsychotic prescriptions. Patients were followed for just over 1 year. New-onset diabetes was identified through diagnostic codes and prescriptions for diabetes medication. In Cox proportional hazards regression adjusting for potential confounders, with patients initiating haloperidol use designated the reference group, diabetes risk was increased equally with new use of olanzapine (hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.22, 2.19), risperidone (HR = 1.60, 95% CI: 1.19, 2.14), or quetiapine (HR = 1.67, 95% CI: 1.01, 2.76). Diabetes risks were higher in patients under age 50 y Continue reading >>
Zyprexa (olanzapine) Causing Diabetes....
Zyprexa (olanzapine) causing diabetes.... Zyprexa (olanzapine) causing diabetes.... I have just been informed that my antipsychotic may be the culprit behind me possibly developing T2 diabetes. After a lot of research on my own, I have discovered that the antipsychotic Zyprexa has a high rate of causing diabetes in persons not prone to it. I have even found where there have been class action suits against the pharmecutical company in past years. I am now aware of the problems it can cause. I am worried that my psychiatrist might take me off of it even though it is helping me tremendously. I will have to have a long talk with her at my next appointment. Has anyone else on the forums taken an antipsychotic that has caused this type of disease? 09/14/2014 - A1c 5.8 Official from PCP, eAG 120 02/16/2015 - A1c 5.9 Official from PCP, eAG 123 02/21/2015 - A1c 6.2 w/ ReliOn A1c Test @ Home 03/24/2015 - Metformin ER 500mg 1/day added to med regimine Recent FBS 178, 150, 140, 154, 140, 140, 138, 218, still ranging 140-160 Officially Pre-Diabetic (if there is such a thing... D.D. Family Getting much harder to control D.D. Family T1 since 1985, MM Pump 2013, CGM 2015 As much as I tire of diabetes, given the choice of being Psychotic or being Diabetic, I'd take Diabetic. Sometimes the side effects are a necessary evil. My best friend's father died of a heart attack when we were in high school. He had had a severe bout with cancer several years before, and one of the life-saving medications he was given was bad news for the heart. He was well aware, as was his wife (but not his kids or anyone else, we found out years later). The drug extended his life for several years, which he lived to the fullest. It was sad that he passed away so early, but without the drug he would have passed Continue reading >>
The Trouble With Zyprexa
Home Psych Central Professional The Trouble with Zyprexa Zyprexa (olanzapine) became rapidly popular after its introduction in the United States in 1996. Its structural similarity to Clozaril (clozapine) led to hopes that it would be as effective for treatment-resistant cases as Clozaril but without the risk of agranulocytosis. It quickly proved itself as an effective agent for both schizophrenia and bipolar mania. In sales, it surpassed Risperdal, which had been released two years earlier. Unfortunately for Lilly, several significant side effect issues have emerged, and over the last year controlled studies have been giving clinicians second thoughts about prescribing Zyprexa at all. For example, a recent article in Archives of General Psychiatry included this rather astonishing caveat: The potential cardiovascular consequences of olanzapine therapy, and its association with the metabolic syndrome, warrant serious consideration of its risk-benefit ratio by treating physicians. (1) What is going on here? Is this is a sober assessment of the real risks of prescribing Zyprexa? Or is it an alarmist over-reaction based on one research groups ax-grinding? In this article I will apply the TCR magnifying glass to the data, claims, and counterclaims, and end up with something useful for you to apply to your practice. Wish me luck. Weight. Does Zyprexa cause weight gain? Theres little controversy here. Even Lilly reps agree that Zyprexa causes more weight gain than its firstline atypical peers (by first line atypicals I mean all those atypicals other than Clozaril, which is considered second-line because of its agranulocytosis risk). The most widely cited study documenting this effect is a meta-analysis written by Allison and colleagues (2), which includes a nice chart comparin Continue reading >>
