Are There Any Safe Antipsychotics in Diabetes Treatment?

Because of the possibility that not all antipsychotics are safe in diabetes treatment, in 2003 the FDA began requiring pharmaceutical companies to use warning labels on atypical antipsychotics ("Do Antipsychotic Medications Cause Diabetes?"). These labels alert people to the risks of antipsychotics and diabetes. This is an important and necessary precaution because atypical antipsychotics are widely used. People take them for many conditions:

• Psychotic disorders like schizophrenia
• Bipolar disorder
• Depression
• Anxiety
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Autism
• Tic disorder
• Tourette’s syndrome
• Eating disorders
• Dementia

These disorders negatively impact lives, and without proper treatment, symptoms can become distressing and disruptive. Atypical antipsychotics are frequently successful in reducing symptoms so that people can live better; however, they carry the risk of the development or worsening of type 2 diabetes.

Antipsychotics and diabetes can be a dangerous combination because antipsychotics often lead to weight gain and hyperglycemia (high blood sugar). This can make someone’s diabetes treatment less effective, with blood glucose levels becoming increasingly difficult to control. Are any antipsychotics safe in diabetes treatment? Here are some things researchers are learning.

Antipsychotics and Diabetes: Different Medications Have Different Risks

Two classes of antipsychotics are available: conventional and atypical. Each alleviates symptoms of psychosis and other mental health conditions. Atypical antipsychotics, the newer class, is used to treat a broader range of conditions. Atypical antipsychotics are also more likely to cause hyperglycemia (high blood sugar levels), which in turn can lead to type 2 diabetes or worsen existing diabetes.

The difference between the two classes has to do with how they work in the brain. That said, medical professionals and scientists aren’t entirely sure how either one works but suspect that conventional antipsychotics block dopamine receptors in the brain while atypical antipsychotics block numerous additional chemical receptors (depending on the individual medication) in addition to dopamine.

The conventional class is less likely to cause high blood sugar that the newer class. If you’ve been prescribed any of these medications, your risk of interference with diabetes treatment may be less:

• droperidol (Droleptan)
• fluphenazine (Prolixin)
• flupenthixol (Depixol, Fluanxol)
• haloperidol (Haldol)
• pimozide (Orap)
• thioridazine (Mellaril)
• thiothixene (Navance)
• trifluoperazine (Stelazine)
• zuclopenthixol (Clopixol)

Atypical antipsychotics have a much stronger association with diabetes, largely because of the weight gain that is a common side-effect.  Among the atypical antipsychotics you or a loved one might take:

• aripiprazole (Abilify)
• asenapine (Saphris)
• clozapine (Clozaril, Clopine, Clozapine Synthon, Denzapine, FazaClo, Zaponex)
• iloperidone (Fanapt)
• lurasidone (Latuda)
• paliperidone (Invega)
• quetiapine (Seroquel)
• risperidone (Risperdal)
• ziprasidone (Geodon)

These don’t have equal effects and side effects. Among the atypical antipsychotics, some are safer than others in diabetes treatment.

Atypical Antipsychotics: Which are Safest for Diabetes?

Atypical antipsychotics frequently cause weight gain. This weight gain is often significant enough to lead to obesity, higher low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol), and an increase in triglycerides (lipids, or fats, found in the blood).

Atypical antipsychotics differ in their degree of risk. Those that cause the most weight gain have the closest association with diabetes.

Atypical Antipsychotics That are Most Dangerous for Diabetes

• chlorpromazine (Thorazine)
• clozapine (Clozaril)
• olanzapine (Zyprexa)

Atypical Antipsychotics That Have a Moderate Risk for Diabetes

• risperidone (Risperdal)
• quetiapine (Seroquel)

Atypical Antipsychotics That Have a Lower Risk for Diabetes

• aripiprazole (Abilify)
• ziprasidone (Geodon)

Evidence from multiple studies indicates that safe antipsychotics in diabetes treatment are those that cause the least amount of weight gain and the health problems that come with it, thus making blood sugar levels easier to control. The best antipsychotics for diabetes may be conventional antipsychotics or the atypical antipsychotics aripiprazole and ziprasidone.

The relationship between mental health disorders, antipsychotics, and diabetes is complex. Much is still unknown regarding the relationship between them. Further complicating matters is the fact that everyone is unique. Two people on the same medication won’t experience the same effects. Therefore, to discover the safest antipsychotic medication that carries the lowest diabetes risk, arm yourself with information, and discuss your options with your doctor. When you’re proactive, you have a better chance of minimizing risks and keeping yourself healthy.

article references