Re: Clozapine effective for controlling dyskinesias in people with Parkinson's

[Guest guest]

ne,

Are you aware that this drug also poses a very high risk for

diabetes/diabetic ketoacidosis/hypertriglyceridemia/weight gain, and

even potentially binge eating disorder? It's up there with

olanzapine. If this med is used it is recommended that blood glucose

function be monitored from the onset of use.

Monika M. Woolsey, MS, RD

http://www.afterthediet.com

> Clozapine effective for controlling dyskinesias in people with

severe

> Parkinson's

>

> http://www.eurekalert.org/pub_releases/2004-02/aaon-cef020604.php

>

> ST. PAUL, Minn. – Low-dose clozapine is effective in treating

dyskinesias

> (involuntary, often jerky movements) resulting from long-term

levodopa

> therapy in patients with severe Parkinson's disease, according to a

study

> in the February 10 issue of Neurology, the scientific journal of the

> American Academy of Neurology.

>

> Fifty patients participated in the 10-week, double-blind (where

neither

> patients nor research staff know which participants are receiving

the

> experimental treatment or a placebo) clinical trial performed at

five

> hospitals in France. The patients performed self-evaluations of

their

> motor performance fluctuations every two weeks, by means of a diary

where

> they noted duration and intensity of dyskinesias.

>

> Doses of clozapine (an antipsychotic drug used in managing

schizophrenia)

> averaged 39.4 mg/day. Clozapine was taken once daily in the evening.

>

> " Dyskinesias are normally very difficult to treat and pose a

serious side

> effect of levodopa therapy, the most common treatment for

Parkinson's

> patients, " according to lead study author Franck Durif, MD, at the

Hopital

> Montpied in Clermont-Ferrand. " Our study supports previous

> preliminary findings that low dose clozapine can reduce dyskinesias

by

> around 50 percent in some patients. "

>

> Levodopa-induced dyskinesias (LIDs) are thought to result from

increased

> transmission of dopamine in the brain. Clozapine may be able to

mitigate

> the transmission of toxically high levels of levodopa and thereby

reduce

> its potency and lesson the severity and duration of LIDs, according

to the

> study. " Overstimulation of D1 dopaminergic receptors is believed to

be one

> of the most important mechanisms underlying LIDs in Parkinson's

disease, "

> according to Durif.

>

> The study was supported by a grant from the French Ministry of

Health.

>

> ###

>

> The American Academy of Neurology, an association of more than

19,000

> neurologists and neuroscience professionals, is dedicated to

improving

> patient care through education and research. A neurologist is a

doctor

> with specialized training in diagnosing, treating and managing

disorders

> of the brain and nervous system such as stroke, Alzheimer's disease,

> epilepsy, Parkinson's disease, autism and multiple sclerosis.

>

> For more information about the American Academy of Neurology, visit

its

> web site at www.aan.com.

> --

> ne Holden, MS, RD

> " Ask the Parkinson Dietitian " http://www.parkinson.org/

> " Eat well, stay well with Parkinson's disease "

> " Parkinson's disease: Guidelines for Medical Nutrition Therapy "

> http://www.nutritionucanlivewith.com/

[Guest guest]

I understand completely. I just wanted to be sure you knew the risks.

It's important for all of us to understand how many side effects

these meds can have...and how these drugs are starting to be

prescribed for their side effects in off-label ways.

I just had a heated discussion with a pediatrician who wanted to

prescribe olanzapine to a teen who was 5 lbs. below goal weight

and " stuck " there because of some psychosocial issues. He had no

idea that the weight gain could be due to insulin resistance or that

weight gains in excess of 30 lbs. had been reported. He merely read

one study on its use in anorexia and thought it would be the quickest

way to get the kid to goal weight, rather than exploring the anxiety

that was triggering her increased metabolism.

I wonder if there might not be another atypical antipsychotic with

similar therapeutic effects and fewer risks? In cases like the one I

described above, ED psychiatrists are starting to lean toward Abilify

(aripiprazole) as it can reduce the psychotic thinking and normalize

eating through the back door. Weight gain is achieved without such

metabolic risk. Maybe such a drug would have pertinence in

Parkinson's.

Just a thought,

Monika

[Guest guest]

ne,

This whole area fascinates me. Schenck, sleep scientist with

an interest in night eating, uses a lot of Parkinson's meds with his

sleep disorder clients. After reading about the sleep problems that

these drugs cause in Parkinson's I understand why he does.

Also, knowing how dopamine relates to both sleep and eating, it makes

total sense that you can't just separate the two and try to treat

one. recently told me he thinks I could fill an entire

newsletter on just sleep and eating...so I have taken him up on the

suggestion and we are working on such an issue.

Sounds like we could look at Parkinson's as well some day! The more

connections (and off label uses for these meds) we can find the more

likely it is that someone will want to spend money researching your

favorite people. :-)

Monika

[Guest guest]

Digna,

You're not butting in...and this is a healthy discussion. Thanks for

your input.

Please note that I did say that if you use clozapine you should

consider monitoring insulin function. I did not advise against the

medication completely.

It's really important to understand how many uses these psych meds

have and how we need to manage their use. We will not get that

information from the manufacturer. Almost a year ago I wrote to

Lilly suggesting that they have a diabetes education program for

psychiatrists. I have a very dismissive email here from a top Lilly

exec insisting that weight gain due to olanzapine, in his words, is

an " unscientific rumor " . Now Lilly is advocating for the use of

olanzapine for weight gain in anorexia. So what does this mean?

When there is liability attached it's just a rumor and when there is

money to be made it's an important drug effect? Given the fact that

the FDA has mandated that a diabetes warning be put on this drug,

should there not be a disclaimer that you very well may be achieving

your effect by creating an insulin resistant state?

It's not enough to know what these meds do...we need to understand

how they do it. We as dietitians have a very important obligation,

especially when working with populations who cannot speak up for

themselves (or who are dismissed as unreliable when they try to do

so), to advocate for them.

Monika