What Med Would Work as Well as Geodon & Not Interfere w/Blood Sugar Control?
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Q:  What Med Would Work as Well as Geodon & Not Interfere w/Blood Sugar Control?

My boyfriend who is bipolar is also diabetic, and I understand Geodon and several other meds for bipolar treatment have hyperglycemic side effects.

His doctor's main goal seems to be getting his A1C down, and she has reduced his Geodon to only 20 mg. daily.  He is a completely different person since she did this--unbearable.  This doesn't matter to the doctor because she doesn't have to put up with him.

My question is this--which medicine would work as well as Geodon but NOT interfere with blood sugar control?

Dear Ms. S --

First. I think most anyone -- including most doctors -- would agree that we have to keep in mind quality-of-life in the present when trying to reduce long-term risks to quantity of life. As you point out, this balancing of short and long term goals may come out differently depending on how close a look you get at some of the present-day problems. Doctors are trained quite strongly to watch out for long-term risks such as the possibility of developing diabetes.

In fact, the risk of developing diabetes is such a disaster that it does indeed warrant some pretty major risks to short-term symptom control. On the other hand, there are numerous ways to do this. Turning down Geodon makes sense if the plan is to move on to some alternative agent.

Secondly, it would be important in the able to compare the risk for diabetes of the full dose Geodon versus the risk from the next plan (or from low-dose Geodon; to my knowledge, no one has demonstrated that low-dose Geodon carries less risk of diabetes than full-dose; whereas the effectiveness of this medication is thought to depend rather critically upon dose, with a lower threshold for controlling manic symptoms somewhere around 120 mg in most people, but at least 80 mg or more; and a probable antidepressant-like effect at lower doses, which in some people could make bipolar disorder or worse -- you can see why using Geodon is tricky, especially because the actual dose that enters the bloodstream depends on whether the medication is taken with a meal or not, with much less absorbed if it is taken on an empty stomach).

Geodon is currently thought to be among the least likely to induce diabetes in the family of "atypical antipsychotics", that also includes other anti-manic agents such as Zyprexa and Seroquel. So switching away from Geodon would mean switching away from this class of medications, as the risk would likely be higher with any other medication in that family (with the possible exception of aripiprazole (Abilify), the newest member of that family, which some of my colleagues who use these medications a lot say is slightly more prone to raising blood glucose than Geodon).

You are at a further disadvantage in affecting the choices about the balance between short and long-term risk because you are a "third party", but a very involved one. Good luck with trying to stay useful and preserve your quality of life at the same time, another tricky balance.

Dr. Phelps

Published November, 2007


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