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• W2003442318 abstract "Olanzapine and clozapine are chemically distinct from risperidone.1 The former ones are reported to be associated the most with weight gain, new-onset type 2 diabetes mellitus (DM) and hyperlipidemia,2,3 compared to risperidone.3,4 We here report a schizophrenic patient with oral hypoglycemic agent (OHA)-refractory type-2 DM, whose blood glucose level returned to normal after beginning treatment with risperidone as the alternative to olanzapine. Mr A, a 42-year-old male, had been diagnosed with paranoid schizophrenia for 12 years and had a family history of type 2 DM. He was treated with sulpiride at the dosage of 400 mg/day for his psychotic symptoms for more than 3 years. He was found to have hyperlipidemia with triglyceride 1080 mg/dL and total cholesterol 340 mg/dL, and hyperglycemia with the fasting blood glucose levels around 190 mg/dL. Only gemfibrozil 600 mg/day had been given 3 years ago and the condition was controlled. Because of prominent negative symptoms and functional deterioration, he was then switched to olanzapine at 10 mg/day and his mental status improved gradually. However, with the regular treatment of glimperide 4 mg/day, metformin 2000 mg/day, and gemfibrozil 1200 mg/day, his hyperlipidemia and hyperglycemia exacerbated and remained poorly controlled. His fasting blood glucose levels were abnormal, ranging from 171 to 246 mg/dL and the glycohemoglobin levels were around 12% with the treatment of olanzapine for the past 2 years. We therefore decided to discontinue olanzapine therapy and start with risperidone 2 mg/day instead due to the metabolic dysregulation refractory to the regular OHA treatment. The day after olanzapine was withdrawn, Mr A experienced hypoglycemic-like symptoms, such as dizziness, cold sweating and palpitation. His metformin dose was then tapered by 50%, and his fasting blood glucose levels dropped to 110 mg/dL and remained stable for the five consecutive measurements, ranging from 97 to 113 mg/dL. Moreover, the glycohemoglobin value decreased to 6% in 6 weeks after starting on risperidone. Another significant finding was that his lipid profiles also improved, 227 mg/dL in triglyceride and 203 mg/dL in total cholesterol, even with a 50% tapered dose of lipid-lowering agents. Mr A's psychotic symptoms remained stable for the following 5-month follow up with risperidone therapy. There were many case reports of new-onset or exacerbated diabetes associated with olanzapine treatment;5,6 Although the majority of the patients still required insulin therapy or oral hyperglycemic medication after discontinuing olanzapine,7 some cases found that the hyperglycemia resolved and no further treatment was needed.2,7 It has been suggested that risperidone is associated with a lower propensity for abnormalities in glucose-insulin homeostasis than clozapine4,8 and olanzapine.6–9 This case suggests that risperidone may be an alternative for patients with hyperglycemia, which is associated with atypical antipsychotic drugs. The authors have no financial relationships with any pharmaceutical industry. The work was supported by the grants DOH 94F044, DMR-92-017 and CMU93-M-24 from the Department of Health, the China Medical University and Hospital in Taiwan." @default.
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• W2003442318 date "2006-02-01" @default.
• W2003442318 modified "2023-10-15" @default.
• W2003442318 title "Risperidone alternative for a schizophrenic patient with olanzapine-exacerbated diabetic mellitus" @default.
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• W2003442318 doi "https://doi.org/10.1111/j.1440-1819.2006.01469.x" @default.
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