Kapse Snehal, Ando Hitoshi, Fujiwara Yuki, Suzuki Chisato, Ushijima Kentaro, Kitamura Hiroko, Hosohata Keiko, Kotani Kazuhiko, Shimba Shigeki, Fujimura Akio
Division of Clinical Pharmacology, Department of Pharmacology, School of Medicine, Jichi Medical University, Shimotsuke, Japan.
Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan.
J Pharmacol Sci. 2017 Mar;133(3):139-145. doi: 10.1016/j.jphs.2017.02.008. Epub 2017 Feb 17.
Although rare, second-generation antipsychotic drugs cause severe hyperglycemia within several days after the initiation of therapy. Because glucose tolerance exhibits circadian rhythmicity, we evaluated an effect of a dosing-time on quetiapine-induced acute hyperglycemia in mice. A single intraperitoneal dose of quetiapine dosing-time-independently induced insulin resistance in fasted C57BL/6J mice. However, acute hyperglycemic effect was detected only after dosing of the drug at the beginning of an active phase. Under the conditions in which hepatic glucose production was stimulated by pyruvate administration, hyperglycemic effect of quetiapine was dosing-time-independently observed. In addition, the dosing-time-dependent hyperglycemic effect of quetiapine disappeared in the liver-specific circadian clock-disrupted mice in which circadian rhythmicity in hepatic glucose production is deranged. Furthermore, the dosing-time had little impact on the pharmacokinetics of quetiapine in normal mice. These results suggest that quetiapine acutely causes hyperglycemia only when hepatic glucose production elevates. Therefore, quetiapine therapy with once daily dosing at a rest phase might be safer than that at an active phase. Further studies are needed to confirm the hypothesis.
尽管第二代抗精神病药物引发严重高血糖的情况较为罕见,但在治疗开始后的几天内就会出现。由于葡萄糖耐量呈现昼夜节律性,我们评估了给药时间对喹硫平诱导的小鼠急性高血糖的影响。在禁食的C57BL/6J小鼠中,单次腹腔注射喹硫平会独立于给药时间诱导胰岛素抵抗。然而,仅在活跃期开始给药后才检测到急性高血糖效应。在通过丙酮酸给药刺激肝脏葡萄糖生成的条件下,喹硫平的高血糖效应在给药时间上是独立观察到的。此外,喹硫平的给药时间依赖性高血糖效应在肝脏特异性昼夜节律紊乱的小鼠中消失,在这些小鼠中肝脏葡萄糖生成的昼夜节律被打乱。此外,给药时间对正常小鼠中喹硫平的药代动力学影响很小。这些结果表明,喹硫平仅在肝脏葡萄糖生成升高时才会急性引发高血糖。因此,在休息期每日一次给药的喹硫平治疗可能比在活跃期给药更安全。需要进一步研究来证实这一假设。