Medications

Diabetes Risk and Atypical Antipsychotics

In 2003, the Food and Drug Administation (FDA) requested that the strongest warning be added to the product labels of all atypical antipsychotics. This so-called black box warning advises that these drugs can increase the risk of high blood sugar (hyperglycemia) and diabetes. (Olanzapine is more likely to cause high blood sugar levels than other atypical antipsychotic medicines.) The FDA recommends that:

• Patients with an established diagnosis of diabetes who begin atypical antipsychotic treatment should be regularly monitored for worsening of blood sugar control.
• Patients with risk factors for diabetes (obesity, family history of diabetes) should undergo fasting blood sugar testing at the beginning of atypical antipsychotic treatment and periodically during treatment.
• All patients treated with atypical antipsychotics should be monitored for high blood sugar (hyperglycemia) symptoms.
• Patients who develop hyperglycemia symptoms should undergo fasting blood sugar testing.

There may also be an increased background risk of diabetes in patients with schizophrenia. As a precaution, many doctors advise that all patients treated with atypical antipsychotics receive a baseline blood sugar level reading and be monitored for any increases in blood sugar levels during drug treatment. Patients should also have their lipid and cholesterol levels monitored. [See In-Depth Report #60: Diabetes - type 2.]

Typical Antipsychotic Drugs

The standard typical antipsychotic drug used for schizophrenia is haloperidol (Haldol). Others include:

• Chlorpromazine (Thorazine)
• Perphenazine (Trilafon)
• Thioridazine (Mellaril)
• Mesoridazine (Serentil)
• Trifluoperazine (Stelazine)
• Fluphenazine (Prolixin)

Studies have not shown any significant difference in benefits among these drugs.

The beneficial impact of these drugs is greatest on psychotic symptoms, particularly hallucinations and delusions in the early and midterm stages of the disorder. They are not very successful in reducing negative symptoms. Because of their significant side effects, many patient's stop taking the drug.