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mortality in a population with already increased prevalence an important consideration. When prescribing aripiprazole, a
of obesity, type 2 diabetes mellitus, and cardiovascular commitment to baseline screening and follow-up monitoring
disease.1113 is essential to mitigate the likelihood of developing either
The exact mechanism of how atypical antipsychotics hypoglycemia or hyperglycemia and their associated
promote the development of hyperglycemia and diabetes is complication.
unknown. The development of diabetes and resultant hyper- Clinical adverse events from aripiprazole-induced
glycemia, however, is likely a complex interplay of the hypoglycemia in psychotic patient alone or in combination
atypical antipsychotics likelihood of promoting weight gain with any other oral hypoglycemic agent or any other
(eg, olanzapine and clozapine) through the involvement of drugs with potential of causing hypoglycemia remain an
multiple mechanisms. These mechanisms involve, but are issue with spontaneity and lack of predictability. Until more
not limited to, antagonism at 5-HT receptors (serotonin recep- clinical information becomes available in this matter, close
tors) mainly involving 5-HT2C, which is involved in regula- unlimited active observation by physicians and health care
tion of food intake; antagonism at central histamine H1 professionals are warranted with the use of aripiprazole.
receptors; development of insulin resistance through effects Physicians should keep this rare adverse drug reaction
on cellular glucose transporters; compromised insulin secre- in mind when prescribing this drug. Also patients taking this
tion; and alterations in leptin levels.1416 Sympathetic activa- drug should be made aware of the symptoms of hypoglycemia
tion by second-generation antipsychotics in a mouse study and their blood glucose level should be monitored regularly if
seemed to promote hyperglycemia.16 they exhibit such symptoms. There should be provisions for
Extensive literature survey on metabolic impact sug- early withdrawal of aripiprazole, and emergency oral or
gests favorable metabolic prole of aripiprazole both on intravenous glucose or dextrose should be administered to
glucose homeostasis and serum lipids over other second- prevent and treat a hypoglycemic episode.
generation atypical antipsychotics. However, 2 cases of
diabetic ketoacidosis were reported in people with schizo-
phrenia after starting aripiprazole.1719 REFERENCES
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