Using Zyprexa in someone you suspect has Diabetes?

[ara96]

Hi,
I've been trying to see some intakes at a local center where we don't have ability to get labwork done before patients are seen with us. Typically, we start meds then tell patient's to get their bloodwork done by their future providers. I was wondering, considering how wonderful Zyprexa has worked, is it possible to have the patient start the medication (depending on severity) and have the ongoing provider or PCP just check labs? Some of these patients have very severe symptoms and desperately need medications.

Thanks

---

Members don't see this ad.

 

[Jules A]

I love it but don't use it as often as I'd like due to the side effect profile. An inpatient attending I work with often starts it and recommends the outpatient provider consider a change. It works beautifully in that context but I'm not sure it is realistic to expect that to happen after discharge although the truth is most won't remain compliant on PO.

I'd consider documenting you sent your patients with lab slips. It would be rare they do them but probably not sufficient to simply tell an actively psychotic patient they need labs or expect that your d/c summary reaches and is read by the next provider.

 

[DisorderedDoc417]

I love it but don't use it as often as I'd like due to the side effect profile. An inpatient attending I work with often starts it and recommends the outpatient provider consider a change. It works beautifully in that context but I'm not sure it is realistic to expect that to happen after discharge although the truth is most won't remain compliant on PO.

I'd consider documenting you sent your patients with lab slips. It would be rare they do them but probably not sufficient to simply tell an actively psychotic patient they need labs or expect that your d/c summary reaches and is read by the next provider.

Inpatient all the time for acute psychosis and aggression, I don’t discriminate against the overweight. Then, as noted above we get them started on something else. Usually something with LAI potential if appropriate.

 

[michaelrack]

the title and first post ask 2 questions: 1) can antipsychotics be started without baseline labs and 2) can zyprexa be used in those at high risk (impaired glucose tolerance?) or with DM.
To answer #2, I have a patient with treatment resistant schizophrenia and DM II who I recently started on zyprexa as an inpatient with good response. We did have to increase his metformin dose. So it can be done with good rationale and close monitoring

 

[MacDonaldTriad]

Olanzapine is the closest cousin to Clozapine. It may work a little better in some patients and its side effect profile sucks a little more than anything except Clozapine. If a patient needs clozapine, I give them clozapine even if they have DM. So yes, I give patients Olanzapine even if they have DM. I watch them and the majority tolerate it without metabolic syndrome. If you ask a resident which antipsychotic has the most weight gain and metabolic syndrome liability, they always say Olanzapine, but the right answer is Clozapine.

 

[PistolPete]

I work in a state hospital and start it all the time, even in overweight and diabetic patients, and I’ve found it works beautifully at reducing psychosis and getting someone competent so that we can send them back to court to deal with their charges. Then the hope is that their outpatient psychiatrist changes them to something with a better metabolic profile, but most just stop it altogether since they get lost to f/u since the jails never make f/u appointments.

 

[FlowRate]

I dislike that it's the first-line treatment used by many people around here. While it works well and can be a great option in the case of a patient with prominent agitation (esp if they have a legit haldol allergy) or noncompliance (ODT if cheeking/ IM for court-ordered treatment), there are safer and similarly effective SGA options that could be tried first in a PO-accepting patient.

 

[Blitz2006]

Olanzapine is the closest cousin to Clozapine. It may work a little better in some patients and its side effect profile sucks a little more than anything except Clozapine. If a patient needs clozapine, I give them clozapine even if they have DM. So yes, I give patients Olanzapine even if they have DM. I watch them and the majority tolerate it without metabolic syndrome. If you ask a resident which antipsychotic has the most weight gain and metabolic syndrome liability, they always say Olanzapine, but the right answer is Clozapine.

Yep. I remember a couple years back, I was reading the package inserts. Everyone thinks that Olanzapine is the worst for risk of diabetes. But if I'm not mistaken, risk of diabetes in Clozapine is 33% (vs. 25% for Olanzapine).

 

[ara96]

I work in a state hospital and start it all the time, even in overweight and diabetic patients, and I’ve found it works beautifully at reducing psychosis and getting someone competent so that we can send them back to court to deal with their charges. Then the hope is that their outpatient psychiatrist changes them to something with a better metabolic profile, but most just stop it altogether since they get lost to f/u since the jails never make f/u appointments.

Why is the jail not ensuring they make it to follow up appointments?

 

[thoffen]

Yep. I remember a couple years back, I was reading the package inserts. Everyone thinks that Olanzapine is the worst for risk of diabetes. But if I'm not mistaken, risk of diabetes in Clozapine is 33% (vs. 25% for Olanzapine).

Well yeah clozapine is worse metabolically. But for many reasons it gets thought of separately when discussing antipsychotics a lot of times.

Generally I follow the PORT guidelines. I don't really agree with starting zyprexa to stabilize then switch. But often I'm working with patients who are difficult to keep in outpatient treatment. If someone is having side effects that limit treatment, then I'll switch.

To the OP, I wouldn't start it if I felt someone had undiagnosed diabetes and I couldn't reasonably expect that to be evaluated and treated well in short order. You have to balance benefits and risks. I try to be realistic, though. Just because you have an appropriate plan to have GP f/u a concern isn't enough to me if you think that plan is likely not to be executed as designed.

 

[PistolPete]

Why is the jail not ensuring they make it to follow up appointments?

Dunno. I was stunned when I learned about this from our SW. Apparently no one cares that someone who’s been restored to competency needs f/u appointments. They don’t give them scripts either, regardless what meds they’re on, like seizure meds, HIV meds, psych meds, etc. it’s up to the patient and family, if they have any, to set up their own f/u appts and get meds.

 

[OldPsychDoc]

Why is the jail not ensuring they make it to follow up appointments?

Not their job...