Is it safe to use Garcinia cambogia with olanzapine (atypical antipsychotic medication)?

Garcinia cambogia and Olanzapine: A Potentially Dangerous Combination

Garcinia cambogia should not be used concurrently with olanzapine due to potential serotonergic interactions that could increase the risk of serotonin syndrome and mania with psychosis. 1

Mechanism of Interaction

Garcinia cambogia contains hydroxycitric acid (HCA) as its primary active ingredient, which has been shown to have:

• Serotonergic-enhancing properties through inhibition of selective serotonin reuptake 1
• Muscarinic-enhancing properties via inhibition of acetylcholinesterase 1

These mechanisms create potential for dangerous interactions with olanzapine, which:

• Is an atypical antipsychotic that acts as an antagonist of multiple receptors including serotonin receptors 2
• Should be used with caution when combined with other agents that affect neurotransmitter systems 2

Documented Risks of Garcinia cambogia

1. Psychiatric effects:

   • Multiple case reports of mania and/or psychosis with Garcinia cambogia use 1, 3
   • Onset of psychiatric symptoms between 1-8 weeks after starting Garcinia cambogia 1
   • Serotonin toxicity has been reported 3

2. Other adverse effects:

   • Hepatotoxicity, including acute liver injury, acute hepatitis, and hepatic failure 3, 4
   • Ocular complications including myopic shift, anterior chamber shallowing, and retinal changes 5

Olanzapine Safety Considerations

Olanzapine already carries significant risks that could be exacerbated by concurrent use of Garcinia cambogia:

• Metabolic effects including weight gain, hyperglycemia, and dyslipidemia 2
• Sedation and drowsiness 2
• Potential for drug-drug interactions 2
• Caution advised when using olanzapine concurrently with agents affecting dopamine or other neurotransmitter systems 2

Clinical Recommendations

1. Avoid concurrent use:

   • The Society for Perioperative Assessment and Quality Improvement (SPAQI) explicitly recommends against the use of Garcinia cambogia due to potential for serious adverse effects 2
   • Patients taking olanzapine should be specifically advised to avoid Garcinia cambogia supplements

2. For patients currently taking both:

   • Discontinue Garcinia cambogia immediately
   • Monitor closely for signs of:
     • Serotonin syndrome (agitation, hyperthermia, neuromuscular abnormalities)
     • Mania or psychosis (mood elevation, agitation, delusions)
     • Hepatotoxicity (jaundice, abdominal pain, elevated liver enzymes)

3. For weight management in patients on olanzapine:

   • Consider FDA-approved weight loss medications if appropriate
   • Implement lifestyle modifications including diet and exercise
   • If metabolic effects are severe, discuss with psychiatrist about potential switch to an antipsychotic with lower metabolic risk profile

Monitoring Recommendations

For patients who have been exposed to this combination:

• Mental status examination to assess for signs of mania or psychosis
• Liver function tests to rule out hepatotoxicity
• Blood pressure monitoring (both agents can affect cardiovascular parameters)
• Blood glucose monitoring (olanzapine is associated with hyperglycemia)

Alternative Approaches for Weight Management

Since weight gain is a common concern with olanzapine 2, patients may seek weight loss supplements. Instead of Garcinia cambogia, recommend:

• Consultation with a dietitian
• Structured exercise program
• Regular monitoring of weight and metabolic parameters
• Discussion with psychiatrist about medication options with lower weight gain potential if clinically appropriate

The documented cases of mania with psychosis associated with Garcinia cambogia 1, 3 are particularly concerning for patients already taking psychiatric medications like olanzapine, making this combination potentially dangerous and best avoided.