Magazine article Clinical Psychiatry News

Let Metabolic Effects Drive Antipsychotic Drug Choice

Magazine article Clinical Psychiatry News

Let Metabolic Effects Drive Antipsychotic Drug Choice

Article excerpt

NEW YORK--When prescribing second-generation antipsychotic medications, physicians should start with the agents in this class least likely to cause metabolic adverse effects and only move to prescribing psychotropics with more frequent metabolic effects when necessary, Dr. David C. Henderson said at the meeting.

"If we can get patients off the offending drugs and onto more neutral drugs, their risk [for cardiometabolic adverse events] would be much better," said Dr. Henderson, a psychiatrist at

Harvard Medical School and director of the schizophrenia, weight reduction, and glucose metabolism research program at Massachusetts General Hospital in Boston.

The two worst offenders of the second-generation antipsychotics are clozapine (Clozaril) and olanzapine (Zyprexa). Both drugs cause most patients to gain weight over a prolonged period of time--up to 3.5 years--and they also impair insulin sensitivity. They also pose an "extremely high risk for triggering type 2 diabetes." He estimated that about a third of patients on clozapine develop type 2 diabetes. A much more neutral option is risperidone (Risperdal and various generic formulations). The drugs with the most benign profiles are ziprasidone (Geodon) followed by aripiprazole (Ability), Dr. Henderson said in an interview. The danger that these drugs pose of causing type 2 diabetes "is not a class effect" and, in fact, their risk for this adverse effect is quite variable.

Prescribing these agents with awareness of their relative dangers for triggering weight gain and dampening insulin sensitivity has become more critical in recent years as "use of these drugs has risen dramatically," he said. …

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