DrugBuyers.Com: Health Risks of New Anti-Psychotic Meds

Healthcare professionals are finding that there are potentially dangerous health risks with the Second Generation anti-psychotics, such as respiridone, respiridol,
xyprexia, etc. Ironically, these were developed among other reasons, to eliminate the tardive dyskynesia (shuffling, motor problems, confusion) which was the major side effect of the First Generation meds. Politically, it's noteworthy that this coference was organized by the very companies that manufacture them!

Joint Panel Urges Increased Surveillance for Adverse Effects of Antipsychotic Drugs
A consensus statement published in the February issue of Diabetes Care reviews the association of weight gain and risk of diabetes related to newer antipsychotic medications. The joint panel of the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity gives recommendations for monitoring, management, and counseling. They also note that not all second-generation antipsychotics (SGAs) are associated with increased risk.

"The SGAs are of great benefit to a wide variety of people with psychiatric disorders," write panel chair Eugene Barrett, MD, PhD, from the University of Virginia Health System in Charlottesville, and colleagues. "As with all drugs, SGAs are associated with undesirable side effects. One constellation of adverse effects is an increased risk for obesity, diabetes, and dyslipidemia."

After reviewing all the available literature and hearing presentations from the U.S. Food and Drug Administration and from several manufacturers of SGAs, the joint panel recommended careful screening and monitoring of patients receiving these medications for signs of rapid weight gain or other precursors of diabetes, obesity, and heart disease, with specialist referral as needed.

The panel noted a dramatic increase in the use of SGAs in recent years for schizophrenia spectrum disorders, bipolar disorder, dementia, psychotic depression, autism, and developmental disorders; and, to a lesser extent, delirium, aggressive behavior, personality disorders, and posttraumatic stress disorder.

"Considerable evidence" links treatment with SGAs to rapid weight gain and fat deposition. There is also a documented association between SGA use and the development of prediabetes, diabetes, and elevated blood lipid levels. SGA use may also in some cases be associated with diabetic ketoacidosis.

However, the SGAs vary in their risk profiles. Some SGAs, such as clozapine and olanzapine, are effective but carry a greater risk of weight gain, diabetes, and dyslipidemia.

Before physicians prescribe antipsychotic drugs, the panel recommended that they first screen patients for personal and family history of obesity, diabetes, dyslipidemia, hypertension, and cardiovascular disease; weight and height; waist circumference; blood pressure; fasting plasma glucose; and fasting lipid profile.

Frequent follow-up monitoring is indicated for all patients receiving SGA therapy. Referral to specialists should be considered if problems arise with significant weight gain, new onset diabetes, or other cardiovascular risk factors. All patients who are taking antipsychotic medications and who are overweight or obese should receive counseling regarding nutrition and physical activity.

Pending the results of additional research to more clearly define the risks of SGAs, the known adverse effects of SGAs should guide therapy. Individuals at greatest risk for these complications should be prescribed SGAs least likely to cause them.

Although risks of SGAs should influence management decisions, the panel suggests tailoring treatments to individual patients by weighing the benefits against the risks. "Even for those medications associated with an increased risk of metabolic side effects, the benefits to specific patients could outweigh the potential risks," they conclude.

The consensus development conference was supported in part by an educational grant from AstraZeneca, Bristol-Myers Squibb Co., Janssen Pharmaceutical Products, Eli Lilly and Co., and Pfizer Inc. These pharmaceutical companies also have various financial arrangements with several of the panel members.

Diabetes Care. 2004;27:596-601

Learning Objectives
Upon completion of this activity, participants will be able to:
Evaluate the benefits of SGAs compared with those of older antipsychotics.
List the potential consequences of weight gain and diabetes with respect to particular SGAs.
Clinical Context
The SGA drug class includes clozapine, risperidone, olanzapine, aripiprazole, quetiapine, and ziprasidone. As a class, SGAs offer some definite advantages over their predecessor agents such as haloperidol and chlorpromazine. First, they have been shown to improve not only the positive symptoms of psychosis, but they can aid negative symptoms, such as withdrawal and apathy, as well. They can also help cognitive and affective symptoms in patients with severe psychiatric disease. Finally, this class of drugs does not cause extrapyramidal symptoms at nearly the rate of older medications.

Nonetheless, it has become increasingly clear that these benefits may be derived at some risk in terms of weight gain and diabetes. In a retrospective analysis of data from health plans, Gianfresco and colleagues found that olanzapine, clozapine, and high- and low-potency conventional antipsychotic drugs raised the risk of diabetes in patients with psychosis compared with untreated patients with psychosis. Their research, which appeared in the October 2002 issue of the Journal of Clinical Psychiatry, also demonstrated no increased risk of diabetes associated with risperidone treatment.

Interesting commentary of the validity of the clinical trials that are carried out by the drug comapanies themselves.

anna22

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