TY  - JOUR
AU  - Chehovich, Charisse
AU  - Demler, Tammie Lee
PY  - 2020
DA  - 2020/01/10
TI  - Implications of Clozapine Complications in Geriatric Patients with Type II Diabetes Mellitus
JO  - OBM Geriatrics
SP  - 099
VL  - 04
IS  - 01
AB  - Second-generation antipsychotics, have known metabolic side effects; specifically, clozapine is implicated in worsening or causing hyperglycemia, hypercholesterolemia and weight gain. Recently, there has been an increased interest in the safe use of clozapine in patients with diabetes. In March 2018, a 65-year-old female with a diagnosis of schizophrenia was admitted for inpatient hospitalization to a psychiatric hospital in Buffalo, NY for further stabilization after receiving two months of treatment at a comprehensive psychiatric emergency program (CPEP). Her medical diagnoses included type 2 diabetes mellitus (T2DM), vitamin D deficiency, hyperlipidemia, glaucoma, and constipation. Upon admission, the patient was continued on clozapine, and fluphenazine for treatment of schizophrenia. Her medical medications upon admission included acetaminophen, cholecalciferol, multivitamin, and timolol maleate eye drops. Low blood glucose results at the beginning of her hospitalization led to discontinuation of fingerstick blood glucose readings as the patient was prescribed a controlled diet, and her most recent hemoglobin A1c (HgbA1c) level was 6.8% on March 23, 2018. Clozapine was initiated and titrated over the next four months of inpatient treatment. The patient became psychiatrically stable and was prepared for discharge. During her final medical and psychiatric evaluation laboratory findings included a HgbA1c of 14.4% - a total increase of 7.6% over the course of 31 weeks. Clozapine is implicated in causing health-related complications that include agranulocytosis, seizures, constipation, and hypersalivation, as well as, metabolic side effects such as weight gain and hyperglycemia. Clozapine can also exacerbate pre-existing diabetes or lead to a new diagnosis of T2DM. If not controlled, these metabolic effects can lead to serious long-term consequences. Clozapine was prescribed prior to hospital admission and further titrated during the patient’s hospitalization at a long-term psychiatric facility. The patient had a diagnosis of T2DM but did not receive pharmacotherapy due to well controlled blood glucose and a HgbA1c level within goal. Pending discharge, a final psychiatric and medical examination determined that the patient’s HgbA1c had more than doubled. The significant increase in HgbA1c in a geriatric patient with diet-controlled T2DM confirms that psychiatric medication changes can cause dysregulation of T2DM. Further research is needed to explore any potential increased likelihood, or magnitude of effect, of these drug induced metabolic consequences in older adults.
SN  - 2638-1311
UR  - https://doi.org/10.21926/obm.geriatr.2001099
DO  - 10.21926/obm.geriatr.2001099
ID  - Chehovich2020
ER  -