Analysis of glycemic status in diabetes-naïve patients on statins: A hospital-based cross-sectional study.

INTRODUCTION: Randomized controlled trials, observational studies, and meta-analysis suggest risk of hyperglycemia in patients on statins, and this association is being viewed with renewed interest globally. The present study has tried to explore the possible diabetogenic effect of statins, the mechanism of this effect, and various comorbidities associated with this causation. MATERIALS AND METHODS: This cross-sectional study was carried out at the Department of Cardiology from October 2015 to March 2017. Patients on statins for at least 1 year and normoglycemic at the time of statin initiation were recruited in the study. The outcome of the present study was development of new-onset diabetes mellitus (NODM). Blood glucose levels and insulin levels were estimated. Other adverse reactions of statins and associated comorbidities in the patients were recorded. Descriptive statistics were used to analyze adverse drug reactions. RESULTS: A total of 104 patients met the inclusion criteria, of which eight patients (7.7%) developed NODM and 4 (3.8%) developed prediabetes. Atorvastatin 40 mg was most commonly prescribed statin. About 25% of patients taking atorvastatin 80 mg developed diabetes. CONCLUSION: Statins have a mild-to-moderate risk of developing NODM. The dose of statins is an important factor that increases the risk of diabetes in statin users.

A Case of Hyper Sexuality Probably Associated with Clozapine.

Introduction: Schizophrenia treatment needs to cover several psychological interventions and pharmacological treatment for stabilizing the disease course and decreasing relapses. Sexual side effects are a major hindrance to patients and lead to decreased adherence to therapy and reduced quality of life. Recently, several studies outlined that sexual dysfunction is one of the most distressing side effects of antipsychotics and a major cause of a poor quality of life. We hereby report a case of hypersexuality probably associated with clozapine in a middle-aged woman with schizoaffective disorder. Case Report: 45-year-old female diagnosed as a case of schizoaffective disorder, was initiated on quetiapine 150 mg, risperidone 4 mg, lithium 900 mg for her psychotic and maniac symptoms, and lorazepam 2 mg for insomnia. Due to non-compliance and relapse of symptoms, she was started on clozapine 450 mg which was further increased to 650 mg along with an injectable antipsychotic zuclopenthixol 400 mg. After 3 months of treatment with an increased dose of clozapine, patient exhibited unprovoked and increased sexual urges towards male relatives, exhibitionism and an increased libido compared to normal days. A complete physical examination ruled out any extrapyramidal signs. Clozapine was tapered to 400 mg and stopped. Upon cessation of clozapine, her symptoms of hypersexuality gradually reduced. Conclusions: Clozapine's dopaminergic agonistic effects at the mesolimbic circuit may be responsible for this hypersexuality phenomenon. Poor understanding of the condition by the patient could lead to marital discord and suffering. WHO scale indicates clozapine as the probable cause of sexual dysfunction in our patient.

Sodium Valproate Induced Alopecia: A Case Series.

Drug induced alopecia may range from a barely detectable shedding to an irreversible baldness. Alopecia associated with valproate is a dose-dependent and reversible side effect. We hereby report, three cases of alopecia that occurred in patients who received sodium valproate for various neurological conditions. In all three cases, long term exposure of valproate therapy led to the development of alopecia which eventually resolved after dose reduction or discontinuation. The Naranjo's causality assessment scale indicated valproate as the probable cause of the alopecia in all our patients.

Extrapyramidal Symptoms Probably Related to Risperidone Treatment: A Case Series.

BACKGROUND: Atypical antipsychotics, like risperidone purportedly, score over their typical counterparts in terms of their lower propensity toward producing extrapyramidal symptoms (EPS). However, recent studies have furnished evidence to the contrary. Hereby, we present a case series implicating risperidone as the causative agent for EPS. METHODS: As a part of the pharmacovigilance programme of India, the authors have assessed 10 physician-reported cases of EPS among the 1,830 patients who were prescribed risperidone within the time period of January 2012-December 2014 in a tertiary care hospital in South India. Causality, severity, and preventability assessments of adverse reaction were done as per Naranjo's, Hartwig's, and Thornton'scale respectively. RESULTS: Of the 10 cases, a dose-dependent occurrence of EPS was noted in all and the time duration for development of EPS ranged from 1 week to 2 years. Four patients developed EPS at a dose of 6-8 mg, 4 developed at a dose of 4-6 mg, and the remaining 2 developed at 2 and 1 mg. CONCLUSION: A strong temporal correlation between risperidone and EPS was noted in all cases. High doses produced EPS early, whereas moderate to low doses produced EPS at a later date. Thus, cautious use and close monitoring are warranted in the chronic use of risperidone.