PIOGLITAZONE USED FOR REDUCTION IN CLOZAPINE-ASSOCIATED HYPERTRIGLYCERIDEMIA
Jessica Wehner Lea and Steven C Stoner

OBJECTIVE: To report a case of reduction of triglycerides and hemoglobin (Hb)A_1C concentrations as a result of the use of the thiazolinedione pioglitazone in a psychiatric patient stabilized on clozapine therapy.

CASE SUMMARY: A 49-year-old obese white man, who had uncontrolled diabetes and elevated triglycerides, was stabilized on an antipsychotic regimen using clozapine. After failing sulfonylurea therapy, metformin therapy, and fibric acid therapies, pioglitazone was used to reduce fasting blood glucose and HbA_1c concentrations and reduce mean triglyceride concentrations.

DISCUSSION: Because of the necessity to keep this patient on his current antipsychotic medication and the possible association of exacerbation of diabetes and lipid abnormalities with clozapine, it was necessary to attempt to control the patient's blood glucose and triglycerides through therapeutic means. Numerous attempts to use other diabetic therapies failed. After the addition of pioglitazone to the patient's regimen, significant improvement was observed in the laboratory values, indicating an improvement in diabetes control.

CONCLUSIONS: It appears that pioglitazone has played a role in reducing fasting plasma glucose concentrations and improving insulin sensitivity, while reducing triglycerides and increasing high-density lipoprotein concentrations in this patient. Expanded trials and further investigation are recommended to evaluate the clinical utility of pioglitazone in antipsychotic-associated diabetes and lipid abnormalities.

J Pharm Technol 2002;18:254-6.