Treatment of clozapine-associated weight gain: a systematic review

Abstract

While a number of pharmacological interventions can produce modest weight loss, each may be associated with negative side effects, which should be considered before beginning treatment. Given the pressing need to improve cardiometabolic health in most clozapine-treated patients, substantially more research is needed to develop sound clinical practice guidelines for the treatment of clozapine-associated weight gain.

An update of safety of clinically used atypical antipsychotics

“…The incidence of clozapine-related weight gain is considered to be the most significant at 5% to 35% and almost half of patients may gain 20% or more of their initial body weight, especially if they are on polypharmacy, have a sedentary lifestyle or are not overweight at baseline [77]. Several studies have also associated clozapine treatment with the development of dyslipidemia/hypertension [78].…”

Body and liver fat content and adipokines in schizophrenia: a magnetic resonance imaging and spectroscopy study

“…It is presumed that lipid metabolism is altered in patients treated with antipsychotics (Goncalves et al 2015;Whitney et al 2015;Zimmermann et al 2003). In particular, it is well known that second-generation antipsychotics induce significant weight gain due to blocking various neurotransmitter receptors, particularly serotonin and histamine receptors (Kirk et al 2009).…”

Treatment of clozapine‐associated obesity and diabetes with exenatide in adults with schizophrenia: A randomized controlled trial (CODEX)

“…Although weight loss of 3 kg halves the risk of T2DM, interventions for clozapine‐associated obesity are limited. Most pharmacological treatments have unacceptable side effects, while diets or physical activity have low uptake and acceptability . Although metformin is well tolerated, we found only modest weight loss in obese people using clozapine .…”

“…Most pharmacological treatments have unacceptable side effects, while diets or physical activity have low uptake and acceptability. 5 Although metformin is well tolerated, we found only modest weight loss in obese people using clozapine. 6 Metformin only partially attenuates glucose dysregulation in animal models, highlighting the importance of investigating other interventions.…”