Dramatic Worsening of Type 2 Diabetes Mellitus Due to Olanzapine After 3 Years of Therapy

Abstract

Olanzapine, a serotonin-dopamine-receptor antagonist, is an atypical antipsychotic agent used to treat schizophrenia and other psychotic disorders. It is preferred over older antipsychotics because of its relatively low frequency of sedation, orthostatic hypotension, extrapyramidal symptoms, and anticholinergic side effects. A 45-year-old man with well-controlled type 2 diabetes mellitus experienced an abrupt worsening of his diabetes after 3 years of olanzapine therapy His hemoglobin A1c (HbA1c) level rose from a baseline of 5.9-6.2% to 12.5%. Discontinuation of olanzapine by means of a 3-month taper resulted in a reduction in HbA1c to pretreatment levels. Although cases of olanzapine-induced hyperglycemia have been documented in the literature, this complication has not been reported in a patient maintained on therapy for this duration. Clinicians should be aware of this possible complication in patients receiving long-term olanzapine therapy.

Do Certain Atypical Antipsychotics Increase the Risk of Diabetes? A Critical Review of 17 Pharmacoepidemiologic Studies

“…However, some atypical antipsychotics have been linked to potentially serious metabolic adverse effects, including weight gain, type 2 diabetes mellitus, hyperglycemia, and diabetic ketoacidosis (4)(5)(6)(7)(8)(9). Most case reports of diabetes and diabetic ketoacidosis involve clozapine and olanzapine (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), whereas a smaller number involve risperidone and quetiapine (17,(30)(31)(32)(33)(34)(35). To date, no reports have involved ziprasidone or aripiprazole, but patient exposure to these drugs is limited (36).…”

Hyperglycemia associated with olanzapine treatment

“…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.…”

Fatal Diabetic Ketoacidosis and Antipsychotic Medication

“…The atypical antipsychotic agents include quetiapine, clozapine, olanzapine, risperidone, aripiprazole, and ziprasidone (20)(21)(22)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The ushering in of these second generation antipsychotic medications over the past several decades has rendered first generation antipsychotics all but obsolete due to the extreme efficacy of the former in treating psychotic symptoms, coupled with the greatly diminished motor and sexual side effects relative to older medications.…”