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The Biggest Loser Challenge: A Pill for Atypical Antipsychotic Induced-Weight Gain? Julie A. Dopheide, Pharm.D., BCPP Associate Professor of Clinical Pharmacy,

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Presentation on theme: "The Biggest Loser Challenge: A Pill for Atypical Antipsychotic Induced-Weight Gain? Julie A. Dopheide, Pharm.D., BCPP Associate Professor of Clinical Pharmacy,"— Presentation transcript:

1 The Biggest Loser Challenge: A Pill for Atypical Antipsychotic Induced-Weight Gain? Julie A. Dopheide, Pharm.D., BCPP Associate Professor of Clinical Pharmacy, Psychiatry and the Behavioral Sciences, University of Southern California Schools of Pharmacy and Medicine

2 Relative Risk of Weight Gain  Ziprasidone (Geodon)  Aripiprazole (Abilify)  Risperidone (Risperdal)  Quetiapine (Seroquel)  Olanzapine (Zyprexa)  Clozapine (Clozapine) Low Moderate High Wu Ren-Rong et al. JAMA 2008, Brooks JO et al. Current Psych Reports % of patients receiving antipsychotics increase baseline weight by >7%

3 Metabolic Effects of Atypical Agents Lieberman et al. New Eng J Med 2005 and Allison et al. Am J Psych1999

4 Treatment Options for Antipsychotic Induced Weight Gain  Diet and exercise  Appetite suppressants (psychostimulants, sibutramine)  Blocks fat absorption – orlistat  Blocks glucose production and improves insulin sensitivity - metformin

5 Metformin for Antipsychotic-Induced Weight Gain in Youth Mean Weight Change In kg Weeks N= 39 youth, mean age 13, gained >10% body weight on OLZ, RISP, QUET RCT metformin 500 – 850mg bid or like placebo; ADRs similar both groups Klein DJ, et al. Am Journal of Psychiatry 2006

6 Lifestyle Intervention & Metformin for Antipsychotic Induced Weight Gain  RCT: 12 weeks, Oct 2004 – Dec 2006, China  N= 128, Diagnosis: Schizophrenia  Gained > 10% of baseline weight during 1 st yr  Randomized into 4 groups  Metformin 750mg/day + lifestyle intervention  Metformin 750mg/day alone  Lifestyle intervention + placebo  Placebo  Outcome Measures: BMI, insulin levels, insulin resistance index (IRI), waist circumference Wu Ren-Rong et al. JAMA 2008

7 Lifestyle Intervention & Metformin for Antipsychotic Induced Weight Gain N= 128 Schizophrenia for 9 years Mean age – 26 Olanzapine Risperidone Sulpiride Lifestyle/ Metformin n= 32 Wt kg ( -4.7) BMI ( - 1.8) Waist (-2.0) Insulin (-13.9) IRI ( ) Metformin n= 32 Wt kg (-3.2) BMI (-1.2) Waist (-1.3) Insulin (-12.7) IRI (-3.5) Lifestyle+ Placebo n= 32 Wt kg (-1.4) BMI (-0.5) Waist (0.1) Insulin (-2.7) IRI (-1.0) Placebo n= 32 Wt Kg (3.1) BMI (1.2) Waist (2.2) Insulin (2.1) IRI (0.4) Results: All treatments better than placebo. Best outcome: Lifestyle+metformin (p<0.001 ) ADRs: No sig. differences 5 exacerbations of psychosis 2 in placebo group developed diabetes at week 8

8 When to Consider Metformin  > 7% weight gain over baseline  Good renal function - stable  Positive antipsychotic response requires ongoing treatment  Start low at 250 – 500mg x 1 week, can increase as tolerated  Encourage Lifestyle Intervention


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