Zyprexa and Diabetes
Zyprexa® (olanzapine), an antipsychotic medication marketed and manufactured
by Eli Lilly and Company, has been found to increase the risk of Diabetes
and Hyperglycemia in people who use the drug. In March of 2004 Eli Lilly
released a Dear Doctor letter explaining new labeling changes involving
the diabetes and hyperglycemia risks. The warnings in the Dear Doctor
letter include the following information:
Hyperglycemia and Diabetes Mellitus
Hyperglycemia, in some cases extreme and associated with ketoacidosis
or hyperosmolar coma or death, has been reported in patients treated with
atypical antipsychotics including Zyprexa. Assessment of the relationship
between atypical antipsychotic use and glucose abnormalities is complicated
by the possibility of an increased background risk of diabetes mellitus
in patients with schizophrenia and the increasing incidence of diabetes
mellitus in the general population. Given these confounders, the relationship
between atypical antipsychotic use and hyperglycemia-related adverse events
is not completely understood. However, epidemiological studies suggest
an increased risk of treatment-emergent hyperglycemia-related adverse
events in patients treated with the atypical antipsychotics. Precise risk
estimates for hyperglycemia related adverse events in patients treated
with atypical antipsychotics are not available.
Patients with an established diagnosis of diabetes mellitus who are started
on atypical antipsychotics should be monitored regularly for worsening
of glucose control. Patients with risk factors for diabetes mellitus (e.g.,
obesity, family history of diabetes) who are starting treatment with atypical
antipsychotics should undergo fasting blood glucose testing at the beginning
of treatment and periodically during treatment. Any patient treated with
atypical antipsychotics should be monitored for symptoms of hyperglycemia
including polydipsia, polyuria, polyphagia, and weakness. Patients who
develop symptoms of hyperglycemia during treatment with atypical antipsychotics
should undergo fasting blood glucose testing. In some cases, hyperglycemia
has resolved when the atypical antipsychotic was discontinued; however,
some patients required continuation of anti-diabetic treatment despite
discontinuation of the suspect drug.
Patients who are starting on Zyprexa and have diabetes risk factors,
such as obesity or a family history of diabetes, should have fasting blood
glucose testing when they begin using the drug. Anyone who does have diabetes
when they begin taking Zyprexa should be sure to have their glucose regularly
monitored. For some patients, the hyperglycemia resolved when the drug
was discontinued, but others required continuing treatment for their diabetes
even after they stopped taking the drug.
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