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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Phillipa on November 17, 2009, at 21:21:40
Well it doesn't appear that metformin is a great idea for weight loss with zyprexa. Phillipa
Metformin Shows Potential for Mitigating Olanzapine-Related Weight Gain
Nancy A. Melville
Information from Industry
November 16, 2009 (Las Vegas, Nevada) Antipsychotic drugs commonly cause weight gain, but a new study looking at the antipsychotic drug olanzapine (Zyprexa, Eli Lilly & Co) suggests that adjunctive treatment with metformin, with possible progression to amantadine and then zonisamide, may result in significantly lower levels of weight gain compared with olanzapine alone.Reports in the medical literature have linked amantadine, metformin, and zonisamide to the potential to mitigate or prevent weight gain in patients treated with antipsychotics. In an effort to compare the drugs' effect on weight gain with olanzapine monotherapy, researchers compared 2 treatment algorithms, along with weight management instruction, with olanzapine monotherapy and weight management instruction for patients with schizophrenia or schizoaffective disorder.
The findings were presented here in a scientific poster at the US Psychiatric and Mental Health Congress 2009.
Open-Label Study
In the first arm of the 22-week, open-label study, algorithm A (n = 76), patients received an algorithm of 100 mg of amantadine twice a day, with possible switches to metformin, 1000 to 1500 mg/day, and then to zonisamide, 100 to 400 mg/day.
In the second arm, algorithm B (n = 73), patients started therapy with metformin, 1000 to 1500 mg/day, with possible switches to amantadine, 100 mg twice a day, and then, if necessary, to zonisamide, 100 to 400 mg/day.
In the third arm of the study (n = 50), patients received only olanzapine and no pharmacologic weight management therapy. The mean modal olanzapine doses for all groups ranged from 12.9 to 13.5 mg/day.
The mean baseline weight of the patients ranged from 77.0 through 79.1 kg, and the body mass index (BMI) of the patients ranged from 20 through 35 kg/m2.
Patients with a BMI less than 23 kg/m2 or greater than 30 kg/m2 were limited to a maximum of 25% of enrollment each because of concerns of the influence of baseline BMI on weight gain during olanzapine treatment.
In the algorithm A group, 30 patients (39.5%) switched to metformin during the study period and 7 (9.2%) later switched to zonisamide. For the algorithm B group, 25 patients (34.2%) who started taking metformin switched to amantadine and 9 (12.3%) switched to zonisamide.
At the end of the 22-week study, the least-squares mean weight gain in the monotherapy olanzapine group was 2.8 ± 0.8 kg; in the algorithm A group, the weight gain was 2.4 ± 0.7 kg, whereas for the algorithm B group, the weight gain was just 0.7 ± 0.6 kg.
The P values for weight gain were .11 for olanzapine monotherapy vs algorithm A, .04 for monotherapy vs algorithm B, and .07 for monotherapy vs pooled algorithms A and B.
Primary Outcome Not Met
Although the primary outcome measure for the study a difference in weight gain between olanzapine monotherapy and the combined results for the 2 weight gain treatment algorithms was not met, the researchers said that the findings in algorithm B were nevertheless notable.
"The study failed to meet its primary outcome, but if you just look at [algorithm B], with metformin first, compared to olanzapine monotherapy, then you see the significant feedback," said Michael Case, MS, a statistician with Eli Lilly USA, in Indianapolis, Indiana, and coauthor of the study.
"That finding is interesting and suggests that metformin possibly has an ability to mitigate weight gain in these patients."
Common adverse events in all groups were somnolence, diarrhea, insomnia, nausea, and weight gain; however, significantly more patients in the algorithm B group experienced diarrhea and significantly fewer experienced insomnia compared with the olanzapine-only group.
Olanzapine, like other antipsychotic drugs, causes some patients to develop metabolic syndrome, which is associated with weight gain and adverse metabolic changes, and some have theorized that metformin, a highly popular antidiabetic drug, treats the syndrome.
Cautious Approach Warranted
Gastrointestinal problems are a common adverse effect of metformin, and those effects alone may represent a more basic explanation for a reduction in weight gain, said John W. Newcomer, MD, a professor of psychiatry, psychology, and medicine and medical director of the Center for Clinical Studies at the Washington University School of Medicine in St. Louis, Missouri.
"There's a loosely articulated hypothesis that metformin may help prevent weight gain or cause weight loss somehow as a function of its insulin-sensitizing properties," he said. "But that mechanism has never been proven in this setting, and I think a far more straightforward hypothesis is that it causes weight loss simply through gastrointestinal distress.
"If you look at the diabetes prevention program, the dropout rate in the metformin group was higher than the placebo group," he noted. "Patients don't feel good gastrointestinally, and in a patient population that is already suffering terribly from a major mental disorder, achieving this metabolic benefit by making them feel lousy is probably not the best solution."
Until more substantial data are available on metformin as a preventer of weight gain with antipsychotic drug treatment, Dr. Newcomer urged a cautious approach.
"The evidence base for risk vs benefit with this is so small as to make me very uncomfortable with the idea of metformin being used by psychiatrists in patients who are not diabetic or prediabetic," he said. "It puts metformin in the role of a prevention therapy, and to me that's a whole new domain where risk vs benefit would have to be very carefully evaluated."
Posted by Zyprexa on November 18, 2009, at 2:31:18
In reply to Oh Oh Metformin And Wt Gain With Zyprexa Not Good?, posted by Phillipa on November 17, 2009, at 21:21:40
It sounds like it does have a little weight prevention.
Posted by maxime on November 18, 2009, at 21:08:51
In reply to Oh Oh Metformin And Wt Gain With Zyprexa Not Good?, posted by Phillipa on November 17, 2009, at 21:21:40
I think you read it wrong Phillipa. It says it does help with weight gain.
Posted by Zyprexa on November 19, 2009, at 19:47:09
In reply to Re: Oh Oh Metformin And Wt Gain With Zyprexa Not Good?, posted by Zyprexa on November 18, 2009, at 2:31:18
My doctor even recently said that metformin can help you lose weight.
She took me off it because she wants my liver to be fine. And I don't need it for diabetes any more. A1C now below 5.
Posted by Phillipa on November 20, 2009, at 18:53:07
In reply to Re: Oh Oh Metformin And Wt Gain With Zyprexa Not Good?, posted by Zyprexa on November 19, 2009, at 19:47:09
Zyprexa are there liver problems with it as a neighbor is on it and said someone in California when there said something about some side effect. Couldn't find a thing on google. Love Phillipa
Posted by Zyprexa on November 22, 2009, at 22:36:52
In reply to Re: Oh Oh Metformin And Wt Gain With Zyprexa Not Good? » Zyprexa, posted by Phillipa on November 20, 2009, at 18:53:07
I don't think its particulary hard on liver. But I guess they all have some effect. When I was researching metformin I don't remember anything about it being bad for liver. Just lactic accidosis.
Posted by Phillipa on November 23, 2009, at 19:07:44
In reply to Re: Oh Oh Metformin And Wt Gain With Zyprexa Not Good?, posted by Zyprexa on November 22, 2009, at 22:36:52
Oh maybe that's why my neighbor was concered he's diabetic. Phillipa
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