From the Guidelines
Olanzapine is associated with an increased risk of metabolic disturbances, but there is no direct evidence to suggest it causes metabolic acidosis. The medication is known to increase the risk of type 2 diabetes and has various effects on metabolic parameters, including glucose concentration, hyperglycemia, and weight gain 1. Patients taking olanzapine should be monitored for metabolic parameters, including blood glucose and lipid profiles, especially if they show concerning symptoms. Some key points to consider when prescribing olanzapine include:
- Monitoring for prediabetes or diabetes at baseline, rescreening 12–16 weeks after medication initiation, and screening annually thereafter 1
- Being aware of the potential for metabolic disturbances, particularly in patients with pre-existing diabetes, kidney disease, liver impairment, or those taking concomitant medications that affect metabolism
- Considering the use of pharmacogenetics to determine the optimal treatment approach and minimize the risk of adverse effects 1 It is essential to weigh the benefits and risks of olanzapine and consider alternative treatment options if necessary, to minimize the risk of metabolic disturbances and ensure the best possible outcome for the patient.
From the Research
Metabolic Acidosis and Olanzapine
- Olanzapine has been associated with metabolic side effects, including hyperglycemia and acidosis, as reported in a case study published in the Journal of Intensive Care Medicine 2.
- A review of in vivo models and treatment approaches suggests that olanzapine can induce metabolic dysfunction, including rapid perturbations in glucose and lipid metabolism 3.
- Another case report published in Pharmacotherapy describes a patient who developed severe hyperglycemia, ketonuria, and acidosis after starting olanzapine, highlighting the potential for delayed recognition of complications associated with diabetes in patients taking this medication 4.
Risk Factors and Metabolic Parameters
- A prospective cohort study found that olanzapine treatment was associated with dose-dependent alterations in weight and metabolic parameters, including increases in glucose levels and blood pressure 5.
- A naturalistic 12-month follow-up study found that olanzapine treatment was associated with significant weight gain and increases in total cholesterol and glucose levels, but the metabolic profile did not show the same magnitude of change as the weight gain 6.
- These studies suggest that olanzapine can cause metabolic acidosis, particularly in patients with risk factors for diabetes or those taking high doses of the medication 2, 4, 5.