NEW YORK — Taking baseline measurements of fasting blood glucose, lipids, weight, and waist circumference and monitoring those measures are essential to the early identification of metabolic complications in patients taking atypical antipsychotics, Dr. Harold E. Carlson said.
But Dr. Carlson, head of endocrinology at Stony Brook University, New York, said it also makes sense to consider alternative drug choices in patients at high risk for metabolic complications.
“If you have a choice, pick a different drug to begin with,” Dr. Carlson said at a psychopharmacology update, sponsored by the American Academy of Child and Adolescent Psychiatry.
Data are not reliable enough to create a firm ranking of the relative metabolic risks of the atypical antipsychotics, but the available information suggests that the two worst offenders are clozapine (Clozaril) and olanzapine (Zyprexa), followed by risperidone (Risperdal) and quetiapine (Seroquel), followed by aripiprazole (Abilify) and ziprasidone (Geodon), he said.
It is possible to stay on top of these potential problems through close monitoring, Dr. Carlson said. For diabetes, obtain fasting blood glucose in all patients at baseline, at 3 months, and every 6 months after that. Fasting blood sugar should be monitored more frequently—monthly or quarterly—in high-risk patients, he said.
Patients at risk for diabetes include patients taking olanzapine or clozapine.
When feasible, consider alternative drug choices for high-risk patients or those with treatment-emergent diabetes mellitus, he said. Keep in mind that the diabetes may remit when the antipsychotic is stopped or changed, he said.
For lipid monitoring, obtain a fasting lipid panel at baseline, at 3 months, and then every 6 months for all patients. Obtain a fasting lipid panel quarterly for high-risk patients. High-risk patients include those with a high body mass index (BMI) or rapid weight gain on the drug, family or personal history of hyperlipidemia or coronary heart disease, and individuals receiving clozapine or olanzapine.
If lipid problems emerge, consider switching to a lower-risk antipsychotic or keep the patient on the drug and treat the lipid problem. Dr. Carlson disclosed financial relationships with several pharmaceutical companies, including Eli Lilly & Co.; Janssen L.P.; Otsuka America Pharmaceutical Inc.; Bristol-Myers Squibb Co.; Cephalon Inc.; McNeil Pediatrics, a division of McNeil-PPC Inc.; and Shire U.S. Inc.
Consider alternative drugs for high-risk patients or those with treatment-emergent diabetes mellitus. DR. CARLSON