Posted by Med Editor on August 28, 2003, at 11:17:11
In reply to Re: Serious side effect reported, posted by Larry Hoover on April 11, 2003, at 16:50:44
I coming in on this string quite a while after the last post--but I found it while doing Web search for my job. I'm a little disturbed about the bruhaha that has been brewing over the past year or so about the link between olanzapine (Zyprexa) and diabetes, which was given special momentum by a Duke Univ study published in 2002. The study was based on a database review and concluded that olanzapine may induce diabetes and related problems. This remains a controversial issue. Atypical antipsychotics in general may cause weight gain and its sequelae (diabetes, cholesterolemia) in some users. The cause, degree, and impact are still under study. In fact, a joint study just completed by the Dept of Veterans Affairs, Boston Univ and the Univ of Chicago concluded that all atypical antipsychotic drugs are associated with diabetes risk but contradicted the Duke study with the finding that a lower rate of diabetes incidence is associated with Zyprexa than with other atypical antipsychotics on the market.
It's good to be informed and cautious about pharmaceuticals. However, the operative word is "informed" -- not propagandized. The side effects of psychotropic drugs, such as olanzapine, have been sensationalized in the media, and lawyers are having a field day with class action suits. Some of this activity might be valid, but some is sheer opportunism and manipulation of a misguided and manipulated public (and manipulation of the mentally ill).
The patient and consumer need to understand that no drug is without side effects. There is no perfect drug for the treatment of schizophrenia, bipolar disorder, etc.,(and I'm guessing you know all of this, Dr Bob) but we have come a long way in the past 40 years in developing safer, more effective drugs. The newer antipsychotic agents are less likely to cause motor defects, are less sedating than older agents and improve cognitive abilities and mood, whereas the older neuroleptics controlled the "positive symptoms" of schizophrenia (hallucinations, etc) but made patients into drooling, twitching zombies. Which is better? A zombie ever at risk for a breakthrough seizure or a patient whose schizophrenia is controlled and can think fairly clearly but who has to take special precautions for glycemic control?
A physician and patient must decide whether the benefits outweight the risks of a given medication. Further, each patient will react differently to a particular medication. This is why it is important to have a several different medications to choose from. Which brings me to another point -- which is health care access to a range of psychotropic agents. Some of the controversy and media play about supposed side effects of a given drug are related to competitive ploys among pharmaceutical manufacturers vying for who gets to be the "gold standard" -- the "preferred agent" on a health plan formulary -- when they should all be on the formulary, giving the physician and patient the leeway to make appropriate therapeutic choices.
> > Drugs for mental illness may be causing diabetes............04/11/2003
> > US FDA is confronted with evidence that a new generation of
> > big-selling drugs such as Zyprexa (Eli Lilly) for Schizophrenia &
> > other mental illnesses, cause life threatening diabetes symptoms.
> > Wall Street Journal, Anand & Burton
>
>
> Thanks for the heads-up.
>
> I am astounded at both the high incidence and the severity of this dysregulation of glucose associated with olanzapine (and other) atypical antipsychotics.
>
> Just use olanzapine and diabetes in any search engine, or in Medline. Astounding that this has not been better publicized, considering it has been nine months since researchers at Duke published a warning.
>
> Look at the incidence.....near 10%. And ketoacidosis. That's serious.
>
> Schizophr Res 2003 Jan 1;59(1):1-6
>
> New-onset diabetes and ketoacidosis with atypical antipsychotics.
>
> Wilson DR, D'Souza L, Sarkar N, Newton M, Hammond C.
>
> Department of Psychiatry, Creighton University School of Medicine, Omaha, NE 68131, USA. wilson@creighton.edu
>
> Information from the Ohio Department of Mental Health (ODMH) database was reviewed retrospectively to identify patients at the Cincinnati center treated with an atypical antipsychotic and who had also been evaluated or treated for diabetes mellitus. Blood glucose levels, glucose tolerance, or other evaluations of diabetes had been conducted in 14 of the 126 patients treated with atypical antipsychotics. In 11 of the 14, new-onset, acute, and marked glucose intolerance developed after treatment with clozapine, olanzapine or quetiapine. Of these, six patients required insulin therapy (four only transiently) and five patients developed diabetic ketoacidosis (DKA). Also, glucose metabolism was labile in all cases, and was transient in two cases with subsequent resolution despite on-going antipsychotic therapy. Certain atypical antipsychotics may be associated with new-onset glucose intolerance, including acute diabetes and ketoacidosis. Monitoring for changes in blood glucose levels in patients taking atypical antipsychotics may be indicated. More systematic study data are clearly needed.
>
>
poster:Med Editor
thread:218530
URL: http://www.dr-bob.org/babble/20030828/msgs/255039.html