Q: What Med Would Work as Well as Geodon & Not Interfere w/Blood Sugar
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.
Published November, 2007