I use it more than I would like to in my child and adolescent population. Many of these kids are more susceptible to weight gain than what would be the case for more traditionally weight-neutral medications in adults, including Abilify, Latuda and Geodon. I find metformin has at least modest effect in reducing some of the weight gain and at times helping with weight loss. Thing is, many of these kiddos with disruptive mood dysregulation disorder and autism really need to be on atypicals to function. I typically don't start metformin with most antipsychotics because parents are squeamish enough about medications and also given that some seem to have zero metabolic sides whatesoever, anyway.
For kids, depending on their age and size, I gradually titrate to 250mg BID to 500mg BID. For adolescents, I often end up going to 750mg BID over time, as 500mg BID doesn't seem to frequently cut it. Sometimes you have to cut the dosages in half or divide doses throughout the day due to nausea.
Of note, kids and adults typically see an improvement in their lipid profile when taking metformin. When it comes down to it, I'd rather see them on metformin than a statin.
