| Summary: | 碩士 === 臺北醫學大學 === 藥學系 === 94 === Long-term use atypical antipsychotics, such as quetiapine (QTP), may cause weight gain, glucose dysregulation, and hepatic dysfunction. Silymarin (SB) is a commercially available product in drug stores and may be used as a dietary supplement. Even though silymarin was reported to act coordinately with insulin to control glucose in certain patients and may reduce insulin resistance (IR), its clinical effect on glucose regulation is unclear. And maybe the effects of QTP on patients with different basal fasting plasma glucose (FPG) levels would be different. In order to understand the effects of QTP on serum metabolic parameters in schizophrenia patients with or without glycemic abnormality, patients diagnosed with schizophrenia were recruited from two long-term care facilities, and their blood samples were taken at baseline and at the end of the titration plus 7-day QTP treatment period (Qss; 300mg once daily). After another 7-day QTP treatments, SB (Legalon®; 70 mg once daily) was then added to drug regimen of patients (n=7) and blood samples were then collected at 7th day (QL) to determine the modulation effects of SB. Patients without taking SB were used as controls (QC; n=2). Among 9 recruited patients, there were 5 men and 4 women (mean age were 45.6 ± 12.6 and 54.5 ± 5.0 years respectively). There was one patient developed diabetes (HbA1c = 6.4%; FPG = 126 mg/dL) at Qss, and his FPG did not return to normal range even QTP was discontinued from his prescription for two and a half months. Among the other 8 treated patients, four patients (50%) were pre-existing impaired fasting plasma glucose (IFG；FPG 100～125 mg/dL；n=3) or even FPG ≥ 126 mg/dL (n=1). Patients were grouping with their clinical characteristics to understand the effects of QTP and SB on different groups. Body weight and body mass index increased in both groups at Qss, even for patients with normal basal FPG level. Moreover, FPG decreased (p = 0.032) and fasting insulin increased in patients with normal basal FPG or HbA1c at Qss, and fasting insulin decreased at QL. There were no differences on triglyceride between groups after using QTP or SB. However, total cholesterol, LDL and HDL of patients with normal basal FPG or HbA1c increased to significantly higher at Qss (p < 0.050), and significantly decreased at QL (p < 0.050) than patients with abnormal basal FPG or HbA1c. While patients with abnormal basal FPG or HbA1c decreased at Qss. In conclusion, body weight assessment is recommended, even for patients with normal basal FPG level. SB may be useful in improving IR. Routine FPG assessment may be necessary for QTP long-term（＞4 weeks） users. In addition, total cholesterol and LDL assessment is recommended even for patients with normal basal FPG and HbA1c level after short term uses. SB may be useful in improving lipid controls. While in patients with abnormal basal FPG or HbA1c level, we recommend to monitor HDL in case of its abnormal decreases. Further studies on large-population and clinical pharmacokinetic analysis are required to clarify long-term effects of QTP and the mechanism of drug interactions.
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