Effects of Olanazapine and Haloperidol on Serum Malondialdehyde, Prolactin Level, Blood Glucose and Lipid Profile in Schizophrenic Patients
AbstractBackground and Objectives: The association of the atypical antipsychotics with hypergly-cemia, elevated lipids, and weight gain was recognized soon after the introduction of clozapine and has become of increased concern as the use and uses of atypical antipsy-chotics have been expanded. The aim of the present study was to investigate the preva-lence of diabetes, dyslipidaemia, lipid peroxidation and hyperprolactinemia in Olanzepine treated patients in comparison with patients treated with haloperidol. Methods: Fifty patients were selected randomly from psychiatric inpatient clinic in Erbil city in Iraqi Kurdistan Region between November 2007 and June 2008. All patients were diagnosed as schizophrenia, and none of them were in acute severe state. Thirty Schizophrenic patients received Haloperidol orally as typical antipsychotic and 20 patients received Olanazapine orally as atypical antipsychotic for a minimum of one month. Fasting blood samples for the assessment of serum malondialdehyde (MDA), lipid profile, fasting blood glucose (FBG) and prolactin levels were obtained after one month of the drug prescribing time. From those fifty patients, 16 patients were selected to follow them prospectively over a mean period of time of 112 days for olanzapine and 75 days for haloperidol. The prospective study includes FBG, lipid profile, BMI and serum MDA. Results: The prevalence of hyperprolactinaemia and lipid peroxidation was higher in Haloperidol treated patients. Whereas, the prevalence of diabetes and dyslipidaemia were higher in Olanazapine treated patients, The mean level of BMI of the Olanazapine group was significantly higher than BMI of the Haloperidol group. There was 6.66 % prevalence of DM in Olanazapine treated patients, but there was no prevalence of DM in Haloperidol treated patients. There was no incidence of diabetes mellitus in the prospective study for both Haloperidol and Olanazapine treated patients. Conclusions:No absolute evidence indicates that the atypical antipsychotic Olanazapine is the cause of diabetes, since the glucose levels of all patients were within normal range and there was no incidence of diabetes in the prospective study in spite of their higher weight and body mass index.
Holand R, Mycek M. Pharmacology. 3rd edn. Lip-pincott-Raven publishers, USA , 2006;149-150.
Waller D, Renwick A, Hillier K. Medical pharma-cology and therapeutics 1st edition. Harcourt pub-lishers, Spain. 2001;64.
Green B. Focus on Olanzapine. Curr Med Res Opin. 2000; 16(2):57-65
Borison RL. Recent advances in the pharmaco-therapy of schizophrenia. Harv Rev Psychiatry 1997; 4(5):255-71
Wells B, DiPiro J, Schwinghammer T, Hamilton C. Pharmacotherapy Handbook. 6th edn., McGraw-Hill publishers, USA. 2006; 737.
Muslih R , Al-Nimer M and Al-Zamely .The level of malondialdehyde after activation with (H2O2 and CuSO4) and inhibition by desferoxamine and molsidomine in the serum of patients with acute myocardial infarction .National journal of chemis-try, 2002; 5:139-148.
Gruen PH, Sachar EJ, Langer G, Altman N, Leifer M, Frantz A, Halpern FS. Prolactin response to neuroleptic drugs in normal and schizophrenic subjects. Arch. Gen. Psychiatry,1978; 35(1):108-116
Crawford AM, Beasley CM & Tollefson GD .The acute and long-term effect of Olanazapine compared with placebo and Haloperidol on se-rum prolactin concentrations. Schizophrenia Re-search.1997; 26: 41-54.
David SR, Taylor CC, Kinon BJ. The effects of Olanazapine, risperidone, and Haloperidol on plasma prolactin levels in patients with schizo-phrenia. Clinical Therapeutics. 2000 ;22: 1085-1096.
Kapur S, Seeman P. Does fast dissociation from the dopamine D2 receptor explain the action of atypical antipsychotics?: a new hypothesis. Am J Psychiatry. 2001;158:360–369 .
Marken PA, Haykal RF, Fisher JN. Management of psychotropicinduced hyperprolactinemia. Clin Pharm. 1992;11:851-856.
Arvindakshan M, Sitasawad S, Debsikdar V. Es-sential polyunsaturated fatty acid and lipid perox-ide levels in never-medicated and medicated schizophrenia patients. Biol Psychiatry. 2003;53:56–64.
Mahadik SP, Mukherjee S, Scheffer R, et al. Ele-vated plasma lipid peroxides at the onset of non-affective psychosis. Biol Psychiatry. 1998;43:674–679 .
Parikh V, Khan MM, Mahadik SP. Differential effects of antipsychotics on expression of antioxi-dant enzymes and membrane lipid peroxidation in rat brain. J Psychiatric Res. 2003; 37:43–51 .
Schillevoort I, de Boer A, Herings RMC. Risk of extrapyramidal syndromes with Haloperidol, risperidone, or Olanazapine. Ann Pharmacother . 2001;35:1517–1522 .
Brown K, Reid A, White T . Vitamin E, lipids, and lipid-peroxidation products in tardive dyskinesia. Biol Psychiatry. 1998 ;43:863–867.
Allison DB, Mentore JL, Moonseong H, Chandler LP, Cappelleri JC, Infante MC & Weiden PJ. An-tipsychotic-Induced weight gain: a comprehensive research synthesis. Am J Psychiatry. 1999; 156: 1686-1696.
Kinon BJ, Basson BR, Gilmore JA & Tollefson GD. Long-term Olanazapine treatment: weight change and weight-related health factors in schizophrenia. J Clin Psychiatry. 2001; 62:92-100.
Wirshing DA, Wirshing WC, Kysar L, Berisford MA, Goldstein D, Pashdag J, Mintz J & Marder SR . Novel antipsychotics: comparison of weight gain liabilities. J Clin Psychiatry. 1999; 62:347-349.
Melkersson K & Dahl M-L. Adverse Metabolic Effects Associated with Atypical Antipsychotics. Literature Review and Clinical Implications. Drugs. 2004;64 (7):701-723.
Lindenmayer J, Czobor P, Volavka J .Changes in Glucose and Cholesterol Levels in Patients With Schizophrenia Treated With Typical or Atypi-cal Antipsychotics. Am J Psychiatry. 2003; 160:290–296
Tan w . Effect of Olanazapine on feeding and selected biochemical factors related to weight
gain .Master thesis. University of Saskatchewan, Canda. 2005.
Patel M, Bapu C, Padh H, Nivsarkar M. Olanazapine induced thrombocythemia in Spra-gue-Dawley rats. Drug Chem Toxicol. 2004; 27(4):379-387.
Expert Panel in Detection, Evaluation, and Treat-ment of High Blood Cholesterol in Adults. Execu-tive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treat-ment Panel III). JAMA . 2001;285:2486-2497.
Meyer JM . A retrospective comparison of lipid, glucose, and weight changes at one year be-tween Olanazapine and risperidone treated inpa-tients, in Proceedings of the 39th Annual Meeting of the American College of Neuropsychopharma-cology, Nashville, Tenn, ACNP.2000.
Meyer JM . Novel antipsychotics and severe hyperlipidemia. J Clin Psychopharmacol. 2001;21:369–374.
Newcomer JW .Abnormalities of glucose me-tabolism associated with atypical antipsychotic drugs. J Clin Psychiatry.2004; 65:36-46.
Wirshing DA, Boyd JA, Meng LR, Ballon JS, Marder SR & Wirshing WC . The effects of novel antipsychotics on glucose and lipid levels. J Clin Psychiatry.2002; 63:856-865.
Casey DE. Dyslipidemia and atypical antipsy-chotic drugs. J Clin Psychiatry.2004; 65[suppl 18]:27-35.
Kinon BJ, Basson BR, Gilmore JA & Tollefson GD. Long-term Olanazapine treatment:weight change and weight-related health factors in schizophrenia. J Clin Psychiatry.2001; 62:92-100.
Koro CE, Fedder DO, L´Italien G, Weiss S, Mag-der LS, Kreyenbuhl J, Revicki D & Buchanan RW. An assessment of the Independent Effects of Olanazapine and Risperidone Exposure on the Risk of Hyperlipidemia in Schizophrenic Patients. Arc Gen Psychiatry. 2002; 59:1021-1026.
The copyright on any article published in Zanco J Med Sci is retained by the author(s) in agreement with the Creative Commons Attribution Non-Commercial ShareAlike License (CC BY-NC-SA 4.0).