Addressing Patient Outcomes

Monitoring Helps Assess Patient Tolerability and Risk

The ADA Consensus* Development Conference has developed screening guidelines to help monitor patients on second-generation antipsychotics for changes in metabolic profile.


*Participating organizations:

  • American Diabetes Association
  • American Psychiatric Association
  • American Association of Clinical Endocrinologists
  • North American Association for the Study of Obesity

Selected safety information

  • Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics, including olanzapine. While relative risk estimates are inconsistent, the association between atypical antipsychotics and increases in glucose levels appears to fall on a continuum and olanzapine appears to have a greater association than some other atypical antipsychotics.
  • Physicians should consider the risks and benefits when prescribing olanzapine to patients with an established diagnosis of diabetes mellitus, or having borderline increased blood glucose levels. Patients taking olanzapine should be monitored regularly for worsening of glucose control. Patients starting treatment with olanzapine should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment.
  • Potential consequences of weight gain should be considered prior to starting olanzapine. Patients receiving olanzapine should receive regular monitoring of weight.
  • Undesirable alterations in lipids have been observed with olanzapine use. Clinical monitoring, including baseline and periodic follow-up lipid evaluations in patients using olanzapine, is recommended. Clinically significant, and sometimes very high (=500 mg/dL), elevations in triglyceride levels have been observed with olanzapine use. Modest mean increases in total cholesterol have also been seen with olanzapine use.


Last Update: 6 Oct 15