Blood Glucose Monitoring Recommended For Subset Of Patients On Clozapine

Apr 14, 1997 - A group of Indiana and Ohio clinicians thinks that close monitoring of blood glucose during initiation of clozapine treatment for refractory psychosis is warranted in patients with diabetes or a family history of diabetes. Dr. Anand P. Popli of the Porter-Starke Counseling Centers in Valparaiso, Indiana, and colleagues at Case Western Reserve University in Cleveland report on four patients in whom clozapine "...was associated with either a de novo onset or a severe exacerbation of pre-existing diabetes mellitus." In each case, the change in glycemic control could not be attributed to weight gain. "Three of the patients have been able to continue on clozapine therapy and have experienced a reduction in psychotic symptoms," the authors report. The researchers note that three of the four patients were black and that race may be a risk factor for poor glycemic control during clozapine administration. "Occult diabetes mellitus should be suspected in any patient newly started on clozapine treatment who develops an alteration of consciousness, polyuria, or increased thirst," Dr. Popli concludes. "In clozapine-responsive patients who develop hyperglycemia, the combination of clozapine with hypoglycemic agents should be considered after informed consent."

J Clin Psychiatry 1997;58:108-111.