Pharmacological Strategies to Counteract Antipsychotic-Induced Weight Gain and Metabolic Adverse Effects in Schizophrenia: A Systematic Review and Meta-analysis

Abstract

When nonpharmacological strategies alone are insufficient, and switching antipsychotics to relatively weight-neutral agents is not feasible, the literature supports the use of concomitant metformin as first choice among pharmacological interventions to counteract antipsychotic-induced weight gain and other metabolic adversities in schizophrenia.

Ameliorating antipsychotic-induced weight gain by betahistine: Mechanisms and clinical implications

“…Barak and colleagues conducted a multicentre randomized, placebo-controlled weight loss trial using betahistine (16,32,48 mg/day) in 281 obese adults for a 12-week treatment [171]. The overall results revealed that betahistine did not induce significant weight loss in obese participants at the above dosages, while the prevalence of adverse events was low.…”

Cardiometabolic Risks in Schizophrenia and Directions for Intervention, 3: Psychopharmacological Interventions

“…Important findings from this meta-analysis 4 are presented in Tables 1 and 2. In summary, there was a reasonably strong evidence base to support the use of only 1 drug, metformin, for either prevention or attenuation of antipsychotic-induced metabolic changes.…”

“…In one of the most recent and most extensive PRISMA-compliant meta-analyses on the subject, Mizuno et al 4 searched several electronic databases and other sources and identified 41 published and 9 unpublished, randomized, placebo-controlled trials of pharmacologic interventions for antipsychotic-induced weight gain and other metabolic adverse effects in samples of patients (pooled N = 2,676) with schizophrenia as the commonest diagnosis.…”

“…a Results presented are from the meta-analysis of Mizuno et al 4 Values for sample size were taken from the forest plots (primary source) and tables (secondary source), but not from the text because of minor discrepancies in numbers across sources. The term weight loss is used for convenience to represent an advantage over placebo in either prevention of weight gain or actual weight loss.…”

“…a Results presented are from the meta-analysis of Mizuno et al 4 Abbreviations: HDL = high-density lipoprotein, LDL = low-density lipoprotein, RCT = randomized controlled trial.…”