Kohen Izchak, Gampel Mordechai, Reddy Lakshmi, Manu Peter
North Shore-Long Island Jewish Health System, The Zucker Hillside Hospital, Geriatric Psychiatry Division, Glen Oaks, NY 11004, USA.
Ann Pharmacother. 2008 Apr;42(4):588-91. doi: 10.1345/aph.1K607. Epub 2008 Mar 25.
To report a case of rapidly occurring hyperglycemia that occurred in a geriatric patient 3 days after treatment with olanzapine.
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.
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.
Clinicians treating elderly patients with olanzapine should be aware of the potential for rapidly developing hyperglycemia and monitor such patients accordingly.
报告一例老年患者在使用奥氮平治疗3天后迅速出现高血糖的病例。
一名89岁男性因痴呆伴行为障碍和精神病入院，开始每日两次服用2.5毫克奥氮平。由于偏执和激动，2天后剂量增加至每日两次5毫克。随后，他出现了高血糖（空腹血糖138毫克/分升），停用奥氮平后血糖恢复正常，在重新每日两次服用2.5毫克奥氮平2天后血糖再次升高（空腹血糖150毫克/分升）。此外，他的整体健康状况恶化，并发急性肾衰竭，变得更加困惑和嗜睡。再次停药后高血糖又得到缓解。
我们推测高血糖的迅速发作及由此产生的医学后遗症是由奥氮平引起的。客观的因果关系评估显示该药物不良事件很可能发生。文献中有许多关于奥氮平导致高血糖的病例报告，但均未报道在用药数天内出现高血糖。虽然服用非典型抗精神病药物的患者体重增加常与高血糖同时出现，但这似乎并非必要的因果因素。近期动物研究数据表明，奥氮平和氯氮平会以剂量依赖的方式迅速损害全身胰岛素敏感性。
用奥氮平治疗老年患者的临床医生应意识到迅速发生高血糖的可能性，并相应地对这类患者进行监测。
