180 - Summary antipsychotic medications risk of di

Summary: antipsychotic medications – risk of diabetes and impaired glucose tolerance

Schizophrenia and related psychoses CHAPTER 1 Frequency of monitoring should be determined by physical factors (e.g. weight gain) and known risk factors (e.g. family history of diabetes, lipid abnormalities, smoking status). In addition, all patients should be asked to look out for and report signs and symptoms of diabetes (fatigue, candida infection, thirst polyuria). Treatment of antipsychotic-­related diabetes Switching to an antipsychotic medication with a lower cardiometabolic risk is often effective in reversing changes in glucose tolerance. In this respect, the most compelling evidence is for switching to aripiprazole,115,116 but also to ziprasidone116 and lurasidone.80,117 Standard antidiabetic treatments are otherwise recommended.88 Pioglitazone118 may have particular benefit, but note the hepatotoxic potential of this drug. GLP-­1 agonists such as liraglutide, exenatide and semaglutide are increasingly used.119–121 Summary: antipsychotic medications – risk of diabetes and impaired glucose tolerance High risk Clozapine, olanzapine Moderate risk Phenothiazines, quetiapine, risperidone Low risk High-­potency FGAs (e.g. haloperidol) Minimal risk Aripiprazole, amisulpride, asenapine, brexpiprazole, cariprazine, lumateperone, lurasidone, ziprasidone Table 1.39  Recommended monitoring for diabetes in patients receiving antipsychotic drugs. Treatment stage Recommended monitoring Ideally Minimum At baseline OGTT or FPG. HbA1C if fasting not possible. UG, RPG Continuing All antipsychotic medications: OGTT or FPG + HbA1C at 4–6 months then every 12 months UG or RPG every 12 months, with symptom monitoring For clozapine and olanzapine or if other risk factors present: OGTT or FPG after 1 month, then every 4–6 months HbA1C is a suitable test for monitoring. But note that this test is not suitable for detecting short-­term change. FPG, fasting plasma glucose; HbA1c, glycated haemoglobin; OGTT, oral glucose tolerance tests; RPG, random plasma glucose; UG, urine glucose.