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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
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.
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.
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.
Posted by AndrewB on August 5, 2000, at 22:12:53
In reply to Re: antipsychotics without weight gain?, posted by Sunnely on August 5, 2000, at 20:42:20
People on ziprasidone actually lost weight in the study I saw.
Amisulpride doesn't seem to cause weight gain in most people, though it can. Low side effect profile, especially in men. Is it effective for ruminations. I don't know. Got rid of my head talk though. For more info. on amisulpride, email me at andrewb@seanet.com for an info. piece I have put together.
AndrewB
Posted by paul on August 6, 2000, at 5:32:17
In reply to Re: antipsychotics without weight gain?, posted by AndrewB on August 5, 2000, at 22:12:53
i am experiencing zero weight gain on seroquel (quetiapine). strange that its as high up in the study as it is. chalk it up to metabolism!
p(c(l))
Posted by JohnL on August 7, 2000, at 4:06:26
In reply to antipsychotics without weight gain?, posted by Andre Allard on August 5, 2000, at 19:00:07
Risperdal is one I haven't tried. But my doc said it was a good choice to avoid weight gain and oversedation common to other APs.
I agree with Andrew that Amisulpride is a fine choice. I never had any weight gain while taking it. I think it's almost a crime that Amisulpride is not known or used in USA psychiatry. It beats other APs by a million miles, with me anyway.
John
Posted by NikkiT2 on August 7, 2000, at 10:56:16
In reply to antipsychotics without weight gain?, posted by Andre Allard on August 5, 2000, at 19:00:07
I take thiorizadine (in conjunction with Effexor XR) and have found my appetite decreased for any other med / combo I've been on. I only take 45mg a day though - 10mg am, 10 mg lunchtime, and 25mg at night)
hope that helps
Nikki
Posted by paul on August 8, 2000, at 23:39:55
In reply to Re: antipsychotics without weight gain?, posted by NikkiT2 on August 7, 2000, at 10:56:16
cam-
what are the weight-gaining stats for seroquel? i'm doing really well on it and just found out that i'm 15 lbs heavier than i thought. other factors-zero exercise, nothing but moving-related tripe, and a pretty sorry excuse for a diet. cant wait to start riding again!
p(c(l))
Posted by Cam W. on August 9, 2000, at 6:48:35
In reply to Re: question for cam, posted by paul on August 8, 2000, at 23:39:55
Paul - Seroquel is low on the list of causing weight gain. It causes more weight gain than ziprasidone (not released) and less than clozapine, olanzapine, or risperdal. When you add the older, conventional antipsychotics into the mix, Seroquel usually causes much more weight gain than loxapine and much less weight gain than chlorpromazine. Again, an important consideration is "your mileage may vary".
Whether a drug will cause will cause weight gain for "you" individually is decided by the way your body is put together. The above ordering is a numbers game based on different populations and these differ slightly, depending upon which reference you use.
With the newer atypical antipsyhotics (like seroquel) I tend to gauge response to the drug by the amount of weight that one gains (better response to the effects of the med = greater propensity to gain weight). Notice how I said "propensity to gain weight". What this means is that you can have a good response to an antipsychotic without gaining weight; if you are very diligent in monitoring your diet and exercise (eg feel hunger a lot - it seems). Usually, the more weight one gains, the better the antipsychotic works (the same can sort of be said for SSRIs).
The avoidance of weight gain may not apply to clozapine, where, no matter what you do, you will probably gain weight. With olanzapine the weight gain seems to peak at 8 months; with risperidone, 2 years (slower rate of weight gain than with the other two). With Seroquel, I do not see much weight gain, but it does happen.
Paraphrasing Bill Wirshing out of UC Berkley (I believe), "The more toxic the atypical antipsychotic, the better it works. Clozapine, highly toxic and highly efficaious. Quetiapine (Seroquel) low toxicity, but it doesn't work."
I used to think that Seroquel didn't work, but in a subset of the population, it works like a damn. Since you are gaining weight the Seroquel is working, therefore (and since I think I know you well enough from your posts to get away with this) get off your butt and do some sit-ups and push-ups; go for long walks. Start the exercising slowly and work your way into doing more or you will be bound to fail. Also, carrot sticks (or those cute little carrots in a bag - Frankenfood?) instead of empty calories (those Cheerios party mix or Doritos).
Lecturing all done. Hope this helps - Cam.
Posted by paul on August 9, 2000, at 14:24:04
In reply to Re: question for cam, posted by Cam W. on August 9, 2000, at 6:48:35
thanks for the rabid reply! the move has taken up every micron of time i have and the amount of time it takes to exercise-with the deeeeeeee-sgusting mizzery weather, coupled with total exhaustion @ the end of the day means ordering a salad from the pizza place and you know the rest. yes-it IS working. once i get out west i plan to once again become a ridin' fool and yes-i'll start out SLOOOOOOWWWWWW. lecture well recieved!
p(c(l))
This is the end of the thread.
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