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An overview of interventions in drug-induced weight gain during clozapine treatment

Anna Emilia Urban, Maria Gałuszko-Węgielnik, Wiesław Jerzy Cubała

Affiliacja i adres do korespondencji
Psychiatr Psychol Klin 2015, 15 (2), p. 76–80
DOI: 10.15557/PiPK.2015.0012
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Streszczenie

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.

Słowa kluczowe
clozapine, weight gain, obesity, metabolic syndrome, pharmacological and behavioural interventions