Olanzapine - indications and physiological consequences in a Dublin city drug treatment centre

First published: 10/05/2019 | Last updated: May 20th, 2019

Aims:

Olanzapine, a second generation neuroleptic, is an effective treatment for schizophrenia-spectrum disorders and mood disorders. Despite its known association with altered lipid and glucose metabolism, there is no standard protocol for monitoring this. This study aimed to quantify serum lipid and glucose levels and assess indications for those prescribed olanzapine in a drug dependent patient cohort.

Design, Setting and Participants:

A case series review was performed in April 2009 of patients then prescribed olanzapine at a drug treatment/ methadone maintenance clinic in Dublin city to determine treatment indication and physiological consequences. Twenty six patients were identified. Case notes were reviewed. Data collected included indication for olanzapine, serum cholesterol, triglycerides and glucose measurements, other medication prescribed and basic demographic data.

Findings:

Six (23.1%) patients had raised serum cholesterol; six (23.1%) had raised triglycerides; three (11.55%) had raised glucose levels. Data was unavailable in nine cases for serum cholesterol, in ten cases for triglycerides and in four cases for serum glucose.

Regarding indication for olanzapine: nine patients (34.65%) had a diagnosis of mood disorder, four (15.4%) had chronic psychotic illness, seven (26.95%) had transient psychotic-type symptoms.

In addition, six patients (23.1%) had been prescribed olanzapine to treat sleep disturbance and reduce irritability.

Olanzapine had been initiated by drug treatment facilities, area adult psychiatric services or by forensic psychiatric services.

Conclusions:

This study highlights olanzapine’s association with metabolic dysregulation, finding raised serum lipid and glucose levels in 23.1% and 11.55% respectively. Given data unavailability, this is possibly an under-estimate.

It also identifies prescribing practices which are not in line with reported indications for olanzapine at this time, with almost a quarter of patients prescribed olanzapine to improve sleep and reduce irritibility. Bearing in mind metabolic consequences associated with treatment, the importance of appropriate prescribing is highlighted. Clear protocols are needed regarding indications for treatment and associated metabolic monitoring of those prescribed olanzapine in this patient population.

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Dr Catherine McCarthy