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July 06, 2006
Metabolic Syndrome Risk Increases with Clozapine Use
What is Metabolic Syndrome:
Metabolic syndrome "is a group of conditions that increase the risk for heart disease, stroke and diabetes. The conditions include high blood pressure, excess body fat around the waist, abnormal levels of cholesterol and triglycerides and insulin resistance. Any one of the conditions increases the risk of serious disease. In combination, the risk grows greater."
Clozapine (Clozaril)is one of the most effective antipsychotic drugs used to treat schizophrenia, and physicians are expected to show an increase in prescription rates of the drug because of this. In April, the investigators reported that clozapine was significantly more effective than the new medications. Patients receiving clozapine were less likely to discontinue treatment than those on other drugs. Close monitoring of patients is needed, Rochester researchers say - to prevent and minimize risk of metabolic syndrome for users of Clozaril.
The increased physical health risks must be balanced with the potential benefits of clozapine, the researchers conclude. In addition to its superior efficacy for patients resistant to conventional antipsychotic drugs, clozapine also is the only medication currently approved by the Food and Drug Administration for the treatment of suicidal behavior.
“We need to raise the awareness of physicians about this issue so they monitor their patients and intervene promptly when required to prevent long-term adverse health consequences,” Lamberti said.
“People with schizophrenia are known to exercise less and have poor diets,” Lamberti said. “Those factors contribute to metabolic syndrome. We can’t say how much clozapine contributes to metabolic syndrome, but we have shown the high prevalence of the syndrome in those who take clozapine.”
In the new study by J. Steven Lamberti, M.D, and his team at University of Rochester Medical Center published in the July issue of the American Journal of Psychiatry, concludes that there may be some significant risks associated with clozapine. (This risk is also shared by the other leading atypical antipsychotic medications - so its a general concern that people who take the medications need to be careful of). They examined weight, measured and tested for diabetes, blood lipids, and blood pressure of 93 patients suffering from schizophrenia and being treated with clozapine for 6 months. These patients were compared to a control group of 2,700 participants matched by demographics.
The study found 53.8% of the patients taking clozapine had metabolic syndrome, while only 20.7% of the control did.
The presence of Metabolic Syndrome in these patients would give them a 2 to 3 fold increase in cardiovascular disease mortality.”
One limitation of this study is that it only proves a correlation between metabolic syndrome and clozapine, and not necessarily that one causes the other. Other factors seen in people with schizophrenia, like exercising less and poor diets, may contribute or increase the risk of metabolic syndrome. And further research comparing other drugs used to treat schizophrenia with clozapine will paint a clearer picture of its role in developing metabolic syndrome (read an editorial on this study).
But even without concrete evidence proving cause and effect, the increased risk is there. Lamberti suggests monitoring glucose and blood lipid levels, blood pressure and body weight, for patients taking clozapine.
Read Original Article:
Prevalence of the Metabolic Syndrome Among Patients Receiving ClozapineAmerican journal Of Psychiatry(http://ajp.psychiatryonline.org/) July 2006.
Clozapine May Impair Glucose Control in Patients with Schizophrenia
Posted by Michelle Roberts at July 6, 2006 05:26 PM
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