To The Editor: Atypical antipsychotics are associated with metabolic side effects, including weight gain, hyperlipidemia, and type II diabetes. We present a case of severe hyperglycemia, hypercholesterolemia, and hypertriglyceridemia during treatment with olanzapine and quetiapine. To our knowledge, this is the highest triglyceride level during antipsychotic treatment reported to date.
This case illustrates severe metabolic adverse effects associated with atypical antipsychotics, and one might question whether the combination of olanzapine and quetiapine increased these effects. The patient presented with severe hyperglycemia and hyperlipidemia, with extreme hypertriglyceridemia. Obesity and uncontrolled diabetes certainly contributed to the presentation. A Naranjo (1) score of 7 indicates a probable association with antipsychotics. Causal inference is limited, since no weights or laboratory values were available prior to olanzapine and quetiapine initiation. However, the increase in lipids after reinitiation of quetiapine supports a relationship of the metabolic presentation with antipsychotic treatment, even with relatively low doses of quetiapine as commonly used off-label for insomnia. Providers should recognize that these low doses may not be benign.
Footnotes
Dr. Carnahan has received research support from Eli Lilly, Wyeth, Forest Laboratories, and Boehringer-Ingelheim. Drs. Reantaso, Teegarden, and Pogue report no competing interests.
This letter (doi: 10.1176/appi.ajp.2007.07020253) was accepted for publication in July 2007.
Reference
1.
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ: A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30:239–245
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