MIND
February 19, 2010

Antipsychotics' Health Risks

Antipsychotic drugs like clozapine and olanzapine can raise the risk of diabetes, but patients are often not monitored.

Second generation antipsychotic drugs (SGAs) can cause significant weight gain, as well as increases in blood sugar and cholesterol. Because of this, guidelines issued in 2004 call for patients taking these drugs to be screened and monitored for these side effects.

A recent study shows that this testing isn't being done.

Anyone who has been taking these medications, or who has a family member taking them, may want to ask their doctor or psychiatrist what type of testing they have had and should be having regularly. The six drugs are aripiprazole, clozapine, olanzapine, quetiapine, and ziprasidone.

Second generation antipsychotics were originally developed to treat schizophrenia... Nowadays, they are also used as a treatment for bipolar disorder and less serious conditions such as depression and are often prescribed by general practitioners.

Individually, these drugs are thought to pose different levels of risk, with clozapine and olanzapine posing the highest risk and aripiprazole being lower risk. But patients taking any of these drugs are supposed to be tested and monitored.

Diabetes is the main concern. The side effects of SGAs can significantly raise the likelihood of developing diabetes.

The study examined records of 109,000 Medicaid patients in California, Missouri and Oregon who were taking SGAs. It found that even though new guidelines lay out the need for testing and monitoring patients, these have essentially not increased since the guidelines were issued. Glucose and lipid testing of SGA users was about as frequent as for users of albuterol, a respiratory medication that does not call for any metabolic testing.

Second generation antipsychotics were originally developed to treat schizophrenia and prescribed by psychiatrists. Nowadays, they are also used as a treatment for bipolar disorder and less serious conditions such as depression and are often prescribed by general practitioners.

By 2003, the side effects of SGAs were well enough understood that the FDA required their makers to include warnings on the drugs' labels about their increased risks. The manufacturers were also required to send letters to doctors and psychiatrists informing them of the warnings and advising them of the need for glucose testing in patients receiving SGAs.

In 2004, a joint committee from the American Diabetes Association and American Psychiatric Association issued guidelines recommending initial testing of weight, blood pressure, and sugar and lipid levels of patients before prescribing SGAs to them. The guidelines also included a monitoring schedule of when to retest patients, to see if taking SGAs was affecting these numbers.

The 2010 study says that these recommendations aren't being followed. It's not clear whether this is because the initial warnings and recommendations were not communicated effectively to doctors and psychiatrists or because they're just not being acted upon. The study did note an increase in prescription of the lower risk SGAs relative to the higher risk ones. The researchers speculate that this may be a way doctors and psychiatrists are attempting to lower their patients' risks without adding in the complications that additional testing could pose.

The results of the study were published in the January 2010 issue of the Archives of General Psychiatry.

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