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Re: antipsychotics without weight gain?

Posted by Sunnely on August 5, 2000, at 20:42:20

In reply to antipsychotics without weight gain?, posted by Andre Allard on August 5, 2000, at 19:00:07

> Do any of you out there know of any anitpsychotics without the weight gain. I know that resperidone is the least weight gaining of the newer aytipical antipsychotics but is there any that do not cause weight gain.

Supposedly, the following antipsychotics induce weight loss or no weight gain at all: 1] loxapine (Loxitane), and 2] molindone (Moban).

The following lists the potential of the other antipsychotics to cause weight gain, in ascending order:

1] ziprasidone (the least weight gain)

2] thiothixene, 3] fluphenazine, 4] haloperidol, 5] risperidone, 6] chlorpromazine, 7] sertindole, 8] quetiapine, 9] thioridazine, 10] olanzapine, 11] zotepine, and

12] clozapine (the greatest weight gain).

Aside from weight gain, among the atypical antipsychotics available in the US, clozapine and olanzapine are more commonly associated with elevations of blood sugar (diabetes) and I believe, also triglyceride levels. For those on clozapine and olanzapine (and perhaps, quetiapine and risperidone, as well), it would be clinically prudent to check the blood sugar and lipid panel periodically (say every 6-12 months) especially those who are high risk: with family history, overweight or obese, sedentary, and African-American descent.

FWIW, for patients on antipsychotics and antidepressants fearful of gaining significant weight from these drugs, doctors sometimes would add topiramate (Topamax) to their medication regimen. Topiramate is FDA-approved as anticonvulsant but has appears to have mood-stabilizing effect, as well.

It was also rumored awhile ago (alleged to have been started here at PB), that the H2 antagonists such as Pepcid may also alleviate weight gain from psychotropic drugs. There may be some validity to this rumor. Recently, another H2 antagonist (nizatidine or Axid) was used as an add-on" therapy to a patient with olanzapine-induced weight gain. After 4 to 5 weeks of treatment, nizatidine caused a subsequently reduction in weight after 4 to 5 weeks of treatment. The authors recommended controlled studies to confirm this observation.

> Also, when is the newer form of olanzapine (zyprexa) coming out. I heard that it is just as effective as olanzapine but without the weight gain.

You are probably referring to ziprasidone, another atypical antipsychotic, reported to cause minimal or no weight gain. It was recently recommended for approval by the FDA Advisory Panel. It should be out in the market, soon.

Sources:

1. Stahl, SM: Psychopharmacology of Antipsychotics, 1999, Martin Dunitz, Ltd, London, UK.

2. Topiramate is being used for weight loss, but it's not a panacea. In: Psychopharmacology Update, November 1999.

3. Do H2 antagonists alleviate weight gain from psychotropic drugs? In: Psychopharmacology Update, October 1999.

4. Sacchetti E, Guarneri L, Bravi D: H2 antagonist nizatidine may control olanzapine-associated weight gain in schizophrenic patients. Biological Psychiatry 2000;48:167-168.


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