以Risperidone作為替代藥物治療Clozapine引起的糖尿病

Remission of Diabetes Mellitus after Switching from Clozapine to Risperidone

背景：精神病藥物例如clozapine 可能會引發代謝症候群。有報告指出某些併發高血糖 的病人在更換另一種抗精神病藥物後，其高血糖得以完全緩解。個案報告：我們報告一位 58 歲女性患有多年精神分裂症病人，合併有為期四個月clozapine 新引發的第二型糖尿病。 我們把clozapine 更換為ziprasidone 歷時七個月後，高血糖仍持續存在。之後再更換ziprasidone 為risperidone 歷時一個月，最後高血糖獲得完全緩解。結論：在本病例中，積極更 換抗精神病藥物有效解除了原本的第二代抗精神病藥物所造成的高血糖。然而這樣的療效， 需要臨床更多的有系統的案例研究。

Background: Antipsychotic drugs such as clozapine are known to potentially cause metabolic syndrome. In some cases, switching to a different second-generation antipsychotic drug (SGA) has been reported to resolve the SGA-induced hyperglycemia. Case Report: We report a case of a 58-year-old woman Taiwanese patient with long-term schizophrenia who had experienced new-onset, clozapineinduced type 2 diabetes mellitus during the preceding four months. We changed clozapine (100-200 mg/day) to ziprasidone (80 mg/day) for seven months, but the change failed to resolve her hyperglycemia. Subsequently, we switched ziprasidone to risperidone (4 mg/day) for one month, and she became normoglycemic (fasting blood glucose level, 92-100 mg/dL). Conclusion: In the case of this patient, the aggressive switching from one SGA to another one effectively resolved the antipsychotic drug-induced hyperglycemia. But clinical observations using a larger number of cases are needed to gain more knowledge in switching among SGAs.