Reprinted from Australian Prescriber ;27 5: Article reprinted in Prescriber Update ;25 2: There is an increased risk of diabetes in patients with schizophrenia and this risk is elevated by some antipsychotic medications, research and antipsychotic medications and diabetes.
The risk is greater with the atypical drugs clozapine and olanzapine and the low potency conventional antipsychotics than with risperidone or high potency conventional valtrex anti-inflammatory. 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. Introduction Antipsychotic drugs and diabetes Table 1: Classification of antipsychotic medications available in Australia Mechanism of antipsychotic-induced diabetes Table 2: Risk of developing diabetes with antipsychotic medication Management of diabetes in patients with schizophrenia References.
An impaired action of insulin insulin resistance in patients with schizophrenia was reported over 55 years ago and later confirmed in Australia. The mechanisms underlying the relationship between schizophrenia and diabetes remain unknown.
It is now clear research and antipsychotic medications and diabetes 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 research and antipsychotic medications and diabetes because of their lower rate of extrapyramidal 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 antibiotics and anesthesia diabetes is 1. Classification of antipsychotic medications available animal allergies to dog food Australia a.
Not all antipsychotics increase the risk of diabetes to the same extent. The mechanisms responsible for the elevated risk of diabetes associated with some antipsychotics are not fully understood.
It is known that the atypical antipsychotics and some of the low potency conventional antipsychotics cause weight gain 6 and that, at least for olanzapine and clozapine, the magnitude of this weight gain correlates with the magnitude of the therapeutic response. Clozapine and olanzapine cause the greatest gain, risperidone and quetiapine moderate gain, and aripiprazole and amisulpride the least gain.
Obesity can precipitate diabetes in susceptible people so weight gain is one mechanism for the increased incidence in diabetes. However, the fact that hyperglycaemia improves quickly after stopping the antipsychotic medication and that diabetes can appear in some patients who do not put on weight, suggests that other mechanisms must be involved, research and antipsychotic medications and diabetes.
A prospective study of 82 patients treated with clozapine also found that the risk of developing diabetes was independent of weight gain. Risk of developing diabetes with antipsychotic medication 4, research and antipsychotic medications and diabetes.
Diabetes related to antipsychotic medication is associated with high insulin concentrations, so it seems that these drugs may aggravate the insulin resistance that already exists in patients with schizophrenia. While some of this is no doubt related to weight gain, it has also been shown that antipsychotics inhibit glucose transport into muscle. There is a strong correlation between the ability of these drugs to inhibit glucose transport in vitro and their capacity to induce hyperglycaemia in vivo.
What needs to be taken into account when treating someone coping with the dual problems of schizophrenia and diabetes? The management of diabetes in patients with a major psychiatric illness is problematic. Weight loss or prevention of weight gain should always be attempted because of the known benefits to other comorbidities associated with obesity. However, even if successful, this approach alone may not reduce the risk of developing or worsening diabetes.
November Diabetes and Antipsychotic Drugs Website: Risk of developing diabetes with antipsychotic medication Management of diabetes in patients with schizophrenia References Introduction An impaired action of insulin insulin resistance in patients with schizophrenia was reported over 55 years ago and later confirmed in Australia.
Antipsychotic drugs and diabetes It is now clear that some antipsychotic medications increase the risk of diabetes in research and antipsychotic medications and diabetes with schizophrenia.
Be alert to the increased risk of diabetes in patients with schizophrenia and the fact that some antipsychotic medications increase the risk.
Monitor blood glucose more frequently in patients with known diabetes who commence antipsychotic medication, research and antipsychotic medications and diabetes. Advise about diet and exercise, but keep in mind that compliance may be particularly difficult for patients with schizophrenia, research and antipsychotic medications and diabetes.
When prescribing hypoglycaemic drugs, try to use once-daily medication so that treatment can be more easily supervised. While metformin the preferred first-line therapy should be given twice daily there are now two sulfonylureas that are available as once daily medication modified-release gliclazide and glimepiride b. There is an increase in cardiovascular mortality in patients with schizophrenia so remember to regularly assess and vigorously treat cardiovascular risk factors such as dyslipidaemia and hypertension.
In psychotic patients who have a family history of diabetes or in those who are from an ethnic group with a high prevalence of diabetes all non-Europeanstry to use an antipsychotic that has less potential for precipitating diabetes, such as risperidone or one of the high potency conventional drugs Table 2. Insulin sensitivity in schizophrenia. Br Med J ;2: Patients on atypical antipsychotic drugs: Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: Br Med J ; Differential effects of gel antibacterial casero agents on the risk of development of type 2 diabetes mellitus in patients with mood disorders.
Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: A five-year naturalistic study. Am J Psychiatry ; J Clin Psychiatry ;62 Suppl 7: Antipsychotic-induced weight gain and therapeutic response: J Clin Psychopharmacol ; Consensus development conference on antipsychotic drugs and obesity and diabetes.
Dwyer DS, Donohoe D. Induction of hyperglycemia in mice with atypical antipsychotic drugs that inhibit glucose uptake, research and antipsychotic medications and diabetes. Pharmacol Biochem Behav ; New generation antipsychotics versus low-potency conventional antipsychotics: