Atypical antipsychotics and dyslipidaemia

• no large-scale trials have quantified the effects of atypical antipsychotic drugs on lipid metabolism
• several studies suggest that changes are concordant with weight changes and that clozapine and olanzapine tend to be associated with adverse changes in serum concentrations of triglyceride and cholesterol (1)
• the largest increases in triglycerides appear to occur with clozapine, olanzapine and quetiapine (2)

"All patients starting antipsychotic drug therapy should be asked about any personal or family history of diabetes, dyslipidaemia, hypertension and cardiovascular disease, and given appropriate advice about diet, exercise and weight control... a fasting blood glucose and lipid profile, and blood pressure, should be checked before treatment is started, after 3 months, and then monitored as appropriate....Use of an antipsychotic with a lower tendency to cause weight gain, glucose intolerance or dyslipidaemia is sensible if assessment reveals an increased risk for developing or exacerbating these conditions ...(1)"

A comprehensive review on the effects of antipsychotic therapy on serum lipids (3):

• high-potency conventional antipsychotics (e.g., haloperidol) and the atypical antipsychotics, ziprasidone, risperidone and aripiprazole, appear to be associated with lower risk of hyperlipidemia
• low-potency conventional antipsychotics (e.g., chlorpormazine, thioridazine) and the atypical antipsychotics, quetiapine, olanzapine and clozapine, are associated with higher risk of hyperlipidemia
• recommended that a lipid panel be obtained at baseline in all patients with schizophrenia, annually thereafter for patients on agents associated with lower risk of hyperlipidemia and quarterly in patients on agents associated with higher risk for hyperlipidemia.
  • "..all patients with persistent dyslipidemia should be referred for lipid-lowering therapy or switched to a less lipid-offending antipsychotic agent..."

Reference:

• 1) Drug and Therapeutics Bulletin (2004); 42(8):57-60.
• 2) British Journal of Diabetes and Vascular Disease (2004); 4(5):303-9.
• 3) Schizophr Res. 2004 Sep 1;70(1):1-17.