Risk of diabetes and dyslipidemia during clozapine and other antipsychotic drug treatment of schizophrenia in Iceland

Ingimarsson, Oddur; MacCabe, James H.; Jónsdóttir, Halldóra; Sigurðsson, Engilbert

doi:10.1080/08039488.2017.1334821

Cited by 21 publications

(9 citation statements)

References 40 publications

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“…Very low rates of pharmacological interventions (other non-pharmacological interventions may have been provided) at study entry were noted for individuals with abnormal lipid parameters. Dyslipidaemia has previously been reported to occur at particularly high rates with clozapine (Stroup et al 2016;Ingimarsson et al 2017); however, both FGA and SGA antipsychotic medications have been associated with lipid dysregulation (Buhagiar & Jabbar, 2019), as was demonstrated in this study. Hypertension was present at higher rates in the LAI antipsychotic group, albeit one recent study noted higher rates of hypertension in a cohort of clozapine patients (56%) than was noted in this study (Lappin et al 2018).…”

Section: Discussionsupporting

confidence: 62%

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Lydon

Vallely

Tummon

et al. 2020

Ir. j. psychol. Med.

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Objectives To examine the rate of monitoring of metabolic syndrome and actual rates of metabolic syndrome in two patient cohorts [clozapine treatment and long-acting injectable (LAI) antipsychotic] who are reviewed on an equally regular basis (1–4 weekly) for administration of treatment. Methods Clinical and laboratory data are examined on 119 patients treated with clozapine and 116 patients treated with LAI antipsychotic medications to determine the rates of metabolic syndrome and evidence of monitoring for metabolic syndrome in the previous 6 months. Individuals with insufficient data from these cohorts were invited to attend for metabolic screening to determine actual rates of metabolic syndrome in these two cohorts of patients. Results All metabolic parameters were monitored to a significantly greater extent in the clozapine cohort (>90%), compared to those treated with LAI antipsychotic medications (<50%) (blood pressure, weight, lipid and glucose levels; p < 0.001). Metabolic syndrome was present in 38.9% of those treated with clozapine compared to 31.1% of patients treated with LAI antipsychotic medications (X2 = 0.54, p = 0.46). Conclusions These findings suggest that a robust screening plan should be in place to monitor for metabolic syndrome in individuals treated with LAI antipsychotic medications. This screening should include measurement of body weight, waist circumference, fasting glucose, lipids and fasting insulin levels. Early recognition of abnormal metabolic parameters allows early intervention, therefore, improving long-term cardiovascular outcomes.

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Section: Discussionsupporting

confidence: 62%

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Lydon

Vallely

Tummon

et al. 2020

Ir. j. psychol. Med.

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“…Nevertheless, as mentioned above, the majority of studies comparing FGAs versus SGAs report that metabolic abnormalities are more common in patients prescribed the latter [45,46]. Furthermore, it is generally accepted that the pediatric and female populations are more susceptible to the metabolic side-effects of SGAs [47].…”

Section: Introductionmentioning

confidence: 99%

Second-Generation Antipsychotics and Dysregulation of Glucose Metabolism: Beyond Weight Gain

Grajales

Ferreira

Valverde

2019

Cells

109

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Second-generation antipsychotics (SGAs) are the cornerstone of treatment for schizophrenia because of their high clinical efficacy. However, SGA treatment is associated with severe metabolic alterations and body weight gain, which can increase the risk of type 2 diabetes and cardiovascular disease, and greatly accelerate mortality. Several underlying mechanisms have been proposed for antipsychotic-induced weight gain (AIWG), but some studies suggest that metabolic changes in insulin-sensitive tissues can be triggered before the onset of AIWG. In this review, we give an outlook on current research about the metabolic disturbances provoked by SGAs, with a particular focus on whole-body glucose homeostasis disturbances induced independently of AIWG, lipid dysregulation or adipose tissue disturbances. Specifically, we discuss the mechanistic insights gleamed from cellular and preclinical animal studies that have reported on the impact of SGAs on insulin signaling, endogenous glucose production, glucose uptake and insulin secretion in the liver, skeletal muscle and the endocrine pancreas. Finally, we discuss some of the genetic and epigenetic changes that might explain the different susceptibilities of SGA-treated patients to the metabolic side-effects of antipsychotics.

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“…Women treated with antipsychotics are 1.7 times more likely to develop metabolic syndrome compared to men and are therefore at a higher risk for cardiovascular disease (CVD) (Bener, Al-Hamaq, & Dafeeah, 2014;Carliner et al, 2014;Huang et al, 2009;Ingimarsson, MacCabe, Haraldsson, Jónsdóttir, & Sigurdsson, 2017;McEvoy et al, 2005) et al, 2001). Increased appetite and food intake can be a result of the antagonistic effect of antipsychotics on several neurotransmitter systems (i.e.…”

Section: Metabolic Side-effects and Risk For Cardiovascular Diseasementioning

confidence: 99%

Antipsychotic medication for women with schizophrenia spectrum disorders

et al. 2021

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There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.

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Risk of diabetes and dyslipidemia during clozapine and other antipsychotic drug treatment of schizophrenia in Iceland

Abstract: Clinicians must take active steps to reduce the risk of T2D and raised triglycerides in patients with schizophrenia. Antipsychotics were associated with a greater risk of T2D developing in females compared to males.

Cited by 21 publications

References 40 publications

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Routine screening and rates of metabolic syndrome in patients treated with clozapine and long-acting injectable antipsychotic medications: a cross-sectional study

Second-Generation Antipsychotics and Dysregulation of Glucose Metabolism: Beyond Weight Gain

Antipsychotic medication for women with schizophrenia spectrum disorders

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