QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kohen, I. Articles by Manu, P. Search for Related Content PubMed PubMed Citation Articles by Kohen, I. Articles by Manu, P.

Rapidly Developing Hyperglycemia During Treatment with Olanzapine

Staff Psychiatrist, North Shore—Long Island Jewish Health System, The Zucker Hillside Hospital, Geriatric Psychiatry Division, Glen Oaks, NY

Mordechai Gampel, MD

Psychiatry Resident, North Shore—Long Island Jewish Health System, The Zucker Hillside Hospital

Lakshmi Reddy, MD

Psychiatry Resident, North Shore—Long Island Jewish Health System, The Zucker Hillside Hospital

Peter Manu, MD

Director of Medical Services, North Shore—Long Island Jewish Health System, The Zucker Hillside Hospital; Professor of Medicine, Albert Einstein College of Medicine, Bronx, NY

Reprints: Dr. Kohen, North Shore—Long Island Jewish Health System, The Zucker Hillside Hospital, Geriatric Psychiatry Division, Ambulatory Care Pavilion—Room 2106, 75-59 263rd St., Glen Oaks, NY 11004, fax 718/962-7712, ikohen{at}nshs.edu

OBJECTIVE: To report a case of rapidly occurring hyperglycemia that occurred in a geriatric patient 3 days after treatment with olanzapine.

CASE SUMMARY: An 89-year-old man was admitted for dementia with behavioral disturbance and psychosis and was started on olanzapine 2.5 mg twice daily. Due to paranoia and agitation, the dose was increased to 5 mg twice daily after 2 days. Subsequently, he developed hyperglycemia (fasting blood glucose 138 mg/dL) that resolved when olanzapine was stopped and recurred (fasting blood glucose 150 mg/dL) after 2 days of rechallenge with olanzapine 2.5 mg twice daily. In addition, his overall medical status worsened, as he developed concurrent acute renal failure and became more confused and lethargic. The hyperglycemia once again resolved with discontinuation of the drug.

DISCUSSION: We postulate that the rapid onset of hyperglycemia and the resulting medical sequelae were due to olanzapine. An objective causality assessment revealed that the adverse drug event was probable. There have been numerous case reports of hyperglycemia with olanzapine in the literature, but none reported hyperglycemia within days of initiation of the medication. Although weight gain often coincides with hyperglycemia in patients taking atypical antipsychotics, it does not seem to be a necessary causal factor. Recent data in animal studies have indicated that olanzapine and clozapine rapidly impair whole-body insulin sensitivity in a dose-dependent manner.

CONCLUSIONS: Clinicians treating elderly patients with olanzapine should be aware of the potential for rapidly developing hyperglycemia and monitor such patients accordingly.

Key Words: geriatrics, hyperglycemia, olanzapine

www.theannals.com, DOI 10.1345/aph.1K607