Drugs Log

Treatment with metformin or lifestyle changes promoting exercise and a healthy diet are both effective in reversing the weight gain associated with antipsychotic medications, according to a clinical trial conducted in China. However, a combination of the two approaches is even better.

Metformin, sold under various trade names such as Glucophage, is primarily used to lower blood sugar in patients with type 2 diabetes.

Dr. Jing-Ping Zhao and associates at the Mental Health Institute of the Second Xiangya Hospital in Changsha note that by lowering glucose production in the liver, metformin prevents weight gain and decreases insulin resistance.

However, its effect on the metabolic complications of antipsychotic medication has not been established, the researchers point out in the Journal of the American Medical Association.

Zhao’s group enrolled 128 adults with schizophrenia who gained more than 10 percent of their body weight after taking an antipsychotic drug for 1 year. They were randomly assigned to receive metformin, placebo, lifestyle interventions plus metformin, or lifestyle interventions plus placebo.

The lifestyle intervention included an educational program, the American Heart Association’s step 2 diet and daily moderate exercise for at least 30 minutes.

“To keep patients with schizophrenia compliant with treatment, they all had to be under the care of their parents or another adult caregiver,” Zhao told Reuters Health.

The subject’s average body mass index was 24.5 at the beginning of the study and the average weight was 64.6 kg (142.4 lbs).Body mass index (BMI) is the ratio of height to weight commonly used to classify individuals as underweight, overweight or in a normal weight range. A BMI of 24.5 is at the top end of the normal range.

After 12 weeks, all measured outcomes had worsened in the placebo group, including a weight gain of 3.1 kg (6.8 lbs).

In the metformin group, all outcomes had improved; subjects lost an average of 3.2 kg (7.1 lbs). Subjects in the lifestyle intervention group lost 1.4 kg (3.1 lbs).

However, the benefits of combined treatment were significantly greater than those achieved by either intervention alone. Weight loss in the combined treatment group averaged 4.7 kg (10.4 lbs).

“We recommend that lifestyle intervention plus metformin be considered first for those with weight gain. If patients cannot tolerate or adhere poorly to lifestyle intervention, they should consider metformin alone,” Zhao advised.

“Of course, the safety of metformin must be ensured,” Zhao stressed.

The team is currently engaged in the next stage of their research, he added. “We are studying the efficacy of long-term metformin and lifestyle intervention, and different doses of metformin, on antipsychotic-induced weight gain.”

Diabetes Drug May Cut Med-Related Weight Gain

Improved diet, more exercise and the diabetes medication metformin can help people suffering with schizophrenia control the weight gain that typically accompanies their medications, a Chinese study suggests.

Three months of both medication and lifestyle change resulted in a loss of two centimeters around the waist as well as improvement in other health measures, such as insulin resistance, the researchers report in the Jan. 9/16 issue of the Journal of the American Medical Association.

Metformin is typically prescribed to help control blood sugar levels in people with diabetes. Previous research has shown that metformin can prevent weight gain in people with diabetes and may help manage weight in some overweight people.

Doctors prescribe atypical antipsychotic (AAP) medications to manage a variety of psychotic disorder and behavioral disturbances, including schizophrenia. However, the drugs often also affect the body’s metabolism, resulting in unhealthy cholesterol levels, weight gain and glucose intolerance.

A team based at the Mental Health Institute of the Second Xiangva Hospital, Central South University, China, tested the effect of metformin and lifestyle changes, together and separately, on the weight and insulin levels of 128 adults with schizophrenia. All the participants had gained at least 10 percent of their body weight after starting antipsychotic medications.

The participants were randomly assigned to one of four groups for 12 weeks, while continuing their medication: One group received a placebo or sugar pill; the second one received 750 milligrams per day of metformin; the third received 750 milligrams per day of metformin with lifestyle intervention; and the fourth went through the lifestyle intervention alone. The lifestyle interventions included health education, diet and exercise.

An analysis of the data found that patients in the combination group and patients who took either metformin or engaged in lifestyle change all reduced their weight, body-mass index (a measure of height and weight), waist circumference, insulin levels and insulin resistance.

The participants who took metformin and changed their diet and exercise saw a decrease of 1.8 in their body-mass index, 3.6 in insulin resistance and lost two centimeters in waist circumference. Metformin alone resulted in an average loss of 1.2 in body-mass index, 3.5 in insulin resistance and 1.3 centimeters from the waist. Those who only exercised and changed their diet saw a loss of 0.5 in body-mass index and 1.0 in insulin resistance, but they were no slimmer at the waist. People who took the placebo continued to increase in body mass, waist and insulin resistance, said the researchers.

Metformin

Brand Names: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet

What is metformin?

Metformin is an oral diabetes medicine that helps control blood sugar levels.

Metformin is for people with type 2 (non-insulin-dependent) diabetes.

Metformin is sometimes used in combination with insulin or other medications, but it is not for treating type 1 diabetes.

Metformin may also be used for purposes other than those listed in this medication guide.
What is the most important information I should know about metformin?
Do not use metformin if you have kidney disease, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

Before taking metformin, tell your doctor if you have liver disease or a history of heart disease.
Some people have developed a life-threatening condition called lactic acidosis while taking metformin. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop taking metformin. Be sure the doctor knows ahead of time that you are using metformin.
Know the signs of low blood sugar (hypoglycemia) and how to recognize them, including hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting, or coma (severe hypoglycemia can be fatal). Always keep a source of sugar available in case you have symptoms of low blood sugar.

What should I avoid while taking metformin?

Avoid drinking alcohol while taking metformin. Alcohol lowers blood sugar and may increase the risk of lactic acidosis while you are taking this medicine.

Metformin side effects
Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting. Stop using metformin and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling short of breath, even with mild exertion;
• swelling or rapid weight gain; or
• fever, chills, body aches, flu symptoms.

Less serious side effects may include:

• headache or muscle pain;
• weakness; or
• mild nausesa, vomiting, diarrhea, gas, stomach pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.