Hyperlipidemia following treatment with antipsychotic medications

Department of Psychiatry, Columbia University, NY State Psychiatric Institute, 1051 Riverside Dr., Unit 24, New York, NY 10032, USA.
American Journal of Psychiatry (Impact Factor: 13.56). 11/2006; 163(10):1821-5. DOI: 10.1176/appi.ajp.163.10.1821
Source: PubMed

ABSTRACT This study attempted to estimate the relative risk of developing hyperlipidemia after treatment with antipsychotics in relation to no antipsychotic treatment.
A matched case-control analysis was performed with pharmacy and claims data from California Medicaid (Medi-Cal). Patients were excluded if they were treated for medical disorders or prescribed medications known to increase their risk of hyperlipidemia. Cases were ages 18 to 64 years with schizophrenia, major depression, bipolar disorder, or other affective psychoses and incident hyperlipidemia. Cases were matched to up to six control subjects by age, sex, race, and psychiatric diagnosis. Both groups were prescribed either no antipsychotic medication or had two or more prescriptions for one and only one antipsychotic medication during the 60 days prior to the first indication of hyperlipidemia (cases) or matched index date (controls) in the billing record. Conditional logistic regressions were used to derive odds ratios and 95% confidence intervals (95% CIs) of each antipsychotic medication in relation to no antipsychotic medication.
A total of 13,133 incident cases of hyperlipidemia were matched to 72,140 control subjects. As compared with no antipsychotic medication, treatment with clozapine (odds ratio: 1.82, 95% CI: 1.61-2.05), risperidone (odds ratio: 1.53, 95% CI: 1.43-1.64), quetiapine (odds ratio: 1.52, 95% CI: 1.40-1.65), olanzapine (odds ratio: 1.56, 95% CI: 1.47-1.67), ziprasidone (odds ratio: 1.40, 95% CI: 1.19-1.65), and first-generation antipsychotics (odds ratio: 1.26, 95% CI: 1.14-1.39), but not aripiprazole (odds ratio: 1.19, 95% CI: 0.94-1.52) was associated with a significant increase in risk of incident hyperlipidemia.
These findings suggest that most commonly prescribed antipsychotic medications increase the risk of developing hyperlipidemia in patients with schizophrenia or mood disorders.

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    • "To our knowledge, there is no proven link between the prescription of baclofen and an increased blood level of triglycerides. Risperidone, and more generally atypical antipsychotics, widely used in schizophrenia and bipolar disorder, is known to cause an increase in triglycerides (Weinbrenner et al., 2009), but this increase is usually small and below 2 g/l (Olfson et al., 2006). We report here an original case of a patient treated with atypical antipsychotic (risperidone) for a type 1 bipolar disorder and high-dose baclofen (HDB) for alcohol dependence who presented a rapid and severe elevation of his blood level of triglycerides. "
    Alcohol and Alcoholism 04/2013; 48(4). DOI:10.1093/alcalc/agt033
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    • "If, from the perspective of clinical efficiency, conventional antipsychotics lived up to expectations, side effects and long-time monitoring leaded these substances in the second-line therapy of psychotic disorders [2] [3]. After 1990, the issue of second-generation antipsychotics (atypical) was considered a true revolution in psychopharmacology. "
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    • "Nevertheless, weight gain may be a misleading factor in the estimation of RIS-induced dyslipidemia. In a recent matched case– control analysis of a large sample of psychotic patients (Olfson et al., 2006), both Quet and RIS were found significantly associated with new-onset hyperlipidemia. Interestingly, RIS monotherapy has been shown to worsen lipid metabolism in long-term treated patients (Murashita et al., 2007). "
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