Blood lactate levels in patients receiving first- or second- generation antipsychotics

Abstract

AimTo compare the blood lactate levels between patients with psychotic disorder receiving first- and those receiving second-generation antipsychotics.MethodsThe study was conducted at the psychiatric inpatient and outpatient clinics of the Split Clinical Hospital from June 6, 2008 to October 10, 2009. Sixty patients with psychotic disorder who were assigned to 6-month treatment were divided in two groups: 30 received haloperidol (first generation antipsychotic) and 30 received olanzapine (second generation antipsychotic). Blood lactate levels, other metabolic parameters, and scores on the extrapyramidal symptom rating scale were assessed.ResultsPatients receiving haloperidol had significantly higher blood lactate levels than patients receiving olanzapine (P < 0.001). They also more frequently had parkinsonism, which was significantly correlated with both haloperidol treatment at 1 month (P < 0.001) and 6 months (P = 0.016) and olanzapine treatment at baseline (P = 0.016), 3 months (P = 0.019), and 6 months (P = 0.021). Also, patients receiving haloperidol had significant correlation between blood lactate and dystonia at 1 month (P < 0.001) and 6 months (P = 0.012) and tardive dyskinesia at 1 month (P = 0.032). There was a significant difference between the treatment groups in lactate levels at all points from baseline to month 6 (P < 0.001).ConclusionIt is important to be aware of the potential effect of haloperidol treatment on increase in blood lactate levels and occurrence of extrapyramidal side effects. Therefore, alternative antipsychotics should be prescribed with lower risk of adverse side effects.Trial identification numberNCT01139463

Olanzapine Activates Hepatic Mammalian Target of Rapamycin: New Mechanistic Insight into Metabolic Dysregulation with Atypical Antipsychotic Drugs

“…A shift to an elevated but incomplete (i.e., anaerobic) glycolysis would favor ATP generation from alternate sources such as lipid oxidation. In support of this hypothesis, OLZ administration increases plasma lactic acid levels in humans (Glavina et al, 2011), which is indicative of increased anaerobic glycolysis. Furthermore, OLZ administration lowers the respiratory exchange ratio in rats (Albaugh et al, 2012), which is indicative of a preferential shift to NEFA over carbohydrates as fuel.…”

Blood lactate levels as a biomarker of antipsychotic side effects in patients with schizophrenia

“…Furthermore, the incidence of Parkinsonian-like manifestations was higher than dystonias. These findings are consistent with previously published studies (Glavina et al, 2011; Markianos et al, 2001; Tohen et al, 2003).…”

“…Although the present findings are in agreement with other reports (Glavinia et al, 2011; Halim et al, 2008), it is important to highlight the novel aspects of the present study. A previous study by Glavina et al (2011) only reported on lactate levels with just two drugs: haloperidol and olanzapine. In addition, the present study preferred to sample arterial blood lactate to minimize contamination from effects of tissue lactate.…”

“…Increased lactate levels are generally associated with increased morbidity and mortality in patients with chronic illnesses or critically ill patients (Bakker and De Lima, 2004; Nichol et al, 2010). Previous studies have shown that both haloperidol and olanzapine therapy of patients with psychotic disorders is associated with increased levels of blood lactate (Glavina et al, 2011). In this present study we have investigated the levels of lactate in the arterial blood of patients taking first-generation (chlorpromazine or haloperidol) or second-generation (risperidone, olanzapine or quetiapine) antipsychotics for the first time, in a three-month follow up study.…”

Effect of antipsychotics on mitochondrial bioenergetics of rat ovarian theca cells

“…Our results are in agreement with in-vivo human studies. Glavina et al (2011) reported that APs increased serum lactate level in patients receiving treatment with HAL and olanzapine (atypical AP). The study has also showed correlation between serum lactate levels and incidence of AP-induced extra-pyramidal side effects.…”