PL EN


Preferences help
enabled [disable] Abstract
Number of results
2015 | 15 | 2 | 76-80
Article title

Przegląd interwencji w polekowym przyroście masy ciała podczas leczenia klozapiną

Content
Title variants
EN
An overview of interventions in drug-induced weight gain during clozapine treatment
Languages of publication
EN PL
Abstracts
EN
Aims and methods: Clozapine is an atypical antipsychotic of choice for the treatment of drug-resistant schizophrenia. It is associated with the risk of adverse effects, such as blood dyscrasia, cardiovascular and metabolic disorders, such as insulin resistance and impaired lipid profile, as well as weight gain. The aim of this article is a review of research into methods (both pharmacological and non-pharmacological) of preventing clozapine-induced weight gain. Antipsychotics, other psychotropic drugs, metabolism-regulating agents and appetite suppressants were assessed in groups of patients treated with clozapine (based on medical databases). Among non-pharmacological interventions, the efficacy of cognitive-behavioural therapy, dietary counselling and exercise programmes was assessed in several patient populations. Results: Among the discussed medications aripiprazole, topiramate, fluvoxamine and metformin appear to be efficacious. Orlistat shows efficacy in males. Cognitive-behavioural therapy was shown to be more effective compared to a brief nutrition education. However, pharmacological, psychotherapeutic and dietary interventions were considered insufficient in balancing the total weight gain. Conclusions: Each of the pharmacological interventions should be individually considered in the context of potential benefits and adverse effects. Non-pharmacological methods are recommended in all cases, regardless of the effect. Clinical practice indicates the need to conduct further research and develop management algorithms to prevent excessive weight gain in patients treated with clozapine.
PL
Cel i metody: Klozapina to atypowy lek przeciwpsychotyczny, stosowany z wyboru w schizofrenii lekoopornej. Z przyjmowaniem klozapiny wiąże się prawdopodobieństwo wystąpienia działań niepożądanych w postaci zaburzeń obrazu krwi oraz zaburzeń sercowo-naczyniowych i metabolicznych, takich jak insulinooporność i zaburzenia profilu lipidowego, a także przyrost masy ciała. Celem niniejszego opracowania jest przegląd badań dotyczących metod (zarówno farmakologicznych, jak i niefarmakologicznych) przeciwdziałania przyrostowi masy ciała indukowanemu klozapiną. Wzięto pod uwagę leki przeciwpsychotyczne i inne psychotropowe oraz te regulujące metabolizm i zmniejszające apetyt; poświęconą im część pracy oparto na badaniach grup chorych leczonych klozapiną (informacje z medycznych baz danych). Spośród interwencji niefarmakologicznych na przykładzie kilku grup pacjentów analizowano psychoterapię poznawczo-behawioralną, poradnictwo dietetyczne i programy ćwiczeń fizycznych. Wyniki: Skutecznymi lekami okazały się aripiprazol, topiramat, fluwoksamina i metformina, a u mężczyzn także orlistat. Wykazano przewagę terapii poznawczo-behawioralnej nad wyłączną krótką edukacją żywieniową. Skuteczność interwencji farmakologicznych, psychoterapeutycznych i dietetycznych jest jednak niewystarczająca, gdyż tylko w niewielkim stopniu równoważy przyrost masy ciała. Wnioski: Podjęcie każdej interwencji farmakologicznej powinno zostać rozważone indywidualnie – w kontekście korzyści i działań niepożądanych. Metody niefarmakologiczne, niezależnie od efektu, są polecane w każdym przypadku. Praktyka kliniczna wskazuje na potrzebę przeprowadzenia większej liczby badań i ustalenia algorytmów postępowania związanych z zapobieganiem nadmiernemu przyrostowi masy ciała u osób leczonych klozapiną.
Discipline
Publisher

Year
Volume
15
Issue
2
Pages
76-80
Physical description
Contributors
  • Klinika Psychiatrii Dorosłych, Gdański Uniwersytet Medyczny, aeu@gumed.edu.pl
  • Klinika Psychiatrii Dorosłych, Gdański Uniwersytet Medyczny
  • Klinika Psychiatrii Dorosłych, Gdański Uniwersytet Medyczny
References
  • Afshar H, Roohafza H, Mousavi G et al.: Topiramate add-on treatment in schizophrenia: a randomised, double-blind, placebo-controlled clinical trial. J Psychopharmacol 2009; 23: 157–162.
  • Alvarez-Jiménez M, Hetrick SE, González-Blanch C et al.: Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry 2008; 193: 101–107.
  • Ball MP, Warren KR, Feldman S et al.: Placebo-controlled trial of atomoxetine for weight reduction in people with schizophrenia treated with clozapine or olanzapine. Clin Schizophr Relat Psychoses 2011; 5: 17–25.
  • Borovicka MC, Fuller MA, Konicki PE et al.: Phenylpropanolamine appears not to promote weight loss in patients with schizophrenia who have gained weight during clozapine treatment. J Clin Psychiatry 2002; 63: 345–348.
  • Brown S: Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997; 171: 502–508.
  • Carrizo E, Fernández V, Connell L et al.: Extended release metformin for metabolic control assistance during prolonged clozapine administration: a 14 week, double-blind, parallel group, placebocontrolled study. Schizophr Res 2009; 113: 19–26.
  • Chen CH, Huang MC, Kao CF et al.: Effects of adjunctive metformin on metabolic traits in nondiabetic clozapine-treated patients with schizophrenia and the effect of metformin discontinuation on body weight: a 24-week, randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2013; 74: e424–e430.
  • Fleischhacker WW, Heikkinen ME, Olié JP et al.: Effects of adjunctive treatment with aripiprazole on body weight and clinical efficacy in schizophrenia patients treated with clozapine: a randomized, double-blind, placebo-controlled trial. Int J Neuropsychopharmacol 2010; 13: 1115–1125.
  • Frogley C, Taylor D, Dickens G et al.: A systematic review of the evidence of clozapine’s anti-aggressive effects. Int J Neuropsychopharmacol 2012; 15: 1351–1371.
  • Hahn MK, Remington G, Bois D et al.: Topiramate augmentation in clozapine-treated patients with schizophrenia: clinical and metabolic effects. J Clin Psychopharmacol 2010; 30: 706–710.
  • Henderson DC, Cagliero E, Gray C et al.: Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. Am J Psychiatry 2000; 157: 975–981.
  • Henderson DC, Fan X, Copeland PM et al.: A double-blind, placebocontrolled trial of sibutramine for clozapine-associated weight gain. Acta Psychiatr Scand 2007; 115: 101–105.
  • Henderson DC, Fan X, Copeland PM et al.: Ziprasidone as an adjuvant for clozapine- or olanzapine-associated medical morbidity in chronic schizophrenia. Hum Psychopharmacol 2009; 24: 225–232.
  • Henderson DC, Freudenreich O, Borba CP et al.: Effects of modafinil on weight, glucose and lipid metabolism in clozapine-treated atients with schizophrenia. Schizophr Res 2011; 130: 53–56.
  • Henderson DC, Kunkel L, Nguyen DD et al.: An exploratory openlabel trial of aripiprazole as an adjuvant to clozapine therapy in chronic schizophrenia. Acta Psychiatr Scand 2006; 113: 142–147.
  • Henderson DC, Sharma B, Fan X et al.: Dietary saturated fat intake and glucose metabolism impairments in nondiabetic, nonobese patients with schizophrenia on clozapine or risperidone. Ann Clin Psychiatry 2010; 22: 33–42.
  • Joffe G, Takala P, Tchoukhine E et al.: Orlistat in clozapine- or olanzapine-treated patients with overweight or obesity: a 16-week randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2008; 69: 706–711.
  • Kane J, Honigfeld G, Singer J et al.: Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45: 789–796.
  • Khazaal Y, Frésard E, Borgeat F et al.: Binge eating symptomatology in overweight and obese patients with schizophrenia: a case control study. Ann Gen Psychiatry 2006; 5: 15.
  • Khazaal Y, Frésard E, Rabia S et al.: Cognitive behavioural therapy for weight gain associated with antipsychotic drugs. Schizophr Res 2007; 91: 169–177.
  • Kumar R: Approved and investigational uses of modafinil: an evidence-based review. Drugs 2008; 68: 1803–1839.
  • Leadbetter R, Shutty M, Pavalonis D et al.: Clozapine-induced weight gain: prevalence and clinical relevance. Am J Psychiatry 1992; 149: 68–72.
  • Lu ML, Lane HY, Lin SK et al.: Adjunctive fluvoxamine inhibits clozapine-related weight gain and metabolic disturbances. J Clin Psychiatry 2004; 65: 766–771.
  • Mamo DC: Managing suicidality in schizophrenia. Can J Psychiatry 2007; 52 (Suppl 1): 59S–70S.
  • Masand PS: Weight gain associated with psychotropic drugs. Expert Opin Pharmacother 2000; 1: 377–389.
  • Mortimer AM, Singh P, Shepherd CJ et al.: Clozapine for treatmentresistant schizophrenia: National Institute of Clinical Excellence (NICE) guidance in the real world. Clin Schizophr Relat Psychoses 2010; 4: 49–55.
  • Rector NA, Beck AT: A clinical review of cognitive therapy for schizophrenia. Curr Psychiatry Rep 2002; 4: 284–292.
  • Roerig JL, Steffen KJ, Mitchell JE: Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS Drugs 2011; 25: 1035–1059.
  • Sachs GS, Guille C: Weight gain associated with use of psychotropic medications. J Clin Psychiatry 1999; 60 Suppl 21: 16–19.
  • Sharpe JK, Stedman TJ, Byrne NM et al.: Energy expenditure and physical activity in clozapine use: implications for weight management. Aust N Z J Psychiatry 2006; 40: 810–814.
  • Sinclair D, Adams CE: Treatment resistant schizophrenia: a comprehensive survey of randomised controlled trials. BMC Psychiatry 2014; 14: 253.
  • Tchoukhine E, Takala P, Hakko H et al.: Orlistat in clozapine- or olanzapine-treated patients with overweight or obesity: a 16-week open-label extension phase and both phases of a randomized controlled trial. J Clin Psychiatry 2011; 72: 326–330.
  • Theisen FM, Linden A, König IR et al.: Spectrum of binge eating symptomatology in patients treated with clozapine and olanzapine. J Neural Transm 2003; 110: 111–121.
  • Tschoner A, Engl J, Laimer M et al.: Metabolic side effects of antipsychotic medication. Int J Clin Pract 2007; 61: 1356–1370.
  • Verrotti A, Scaparrotta A, Agostinelli S et al.: Topiramate-induced weight loss: a review. Epilepsy Res 2011; 95: 189–199.
  • Wernicke JF, Kratochvil CJ: Safety profile of atomoxetine in the treatment of children and adolescents with ADHD. J Clin Psychiatry 2002; 63 Suppl 12: 50–55.
  • Wetterling T, Müssigbrodt HE: Weight gain: side effect of atypical neuroleptics? J Clin Psychopharmacol 1999; 19: 316–321.
  • Wiglusz MS, Cubała WJ, Nowak P et al.: Sibutramine-associated psychotic symptoms and zolpidem-induced complex behaviours: implications for patient safety. Psychiatr Danub 2013; 25 Suppl 2: S143–S145.
  • Wu MK, Wang CK, Bai YM et al.: Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program. Psychiatr Serv 2007; 58: 544–550.
Document Type
review
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.psjd-29597928-b918-4c94-b2e4-b0fb089f1cc9
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.