What do you tell people about weight gain with Zyprexa?

[mshoji786]

I tell them before initiating medication that not everyone will get weight gain but it is a side effect to be aware of. I have a patient who is responding beautifully to the medication and we don't want to change it as it has helped with mood as well as psychosis. However, I was suggesting maybe I can add Metformin to help with weight gain?

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[whopper]

Despite that studies say the weight gain risk is about 40% heck it seems to me to be almost twice the numbers.

Warn the patient that while they may gain only a few pounds a month it could plateau at literally dozens of lbs, maybe even at over a 100 lb weight gain. Also warn them of the metabolic risks such as diabetes. Also tell them it's not their fault if they can't refuse the food. I've seen patients literally faint from hunger trying to resist the craving to eat while on the medication.

They could try Relprevv. The weight gain with that is not at bad as the oral Olanzapine but they could go into a coma from the Relprevv. They could also try another antipsychotic but it might not work as well.

I would tell them to opt for Metformin with Olanzapine if they want to stay on Olanzapine.

 

[birchswing]

Whether or not everyone gains weight, aren't the metabolic effects invariable? From what I recall it only takes a few days of taking Zyprexa to induce increased insulin secretion. The weight gain is secondary to the deranged metabolism. But high insulin levels (and high glucose for that matter) aren't good for anyone. For that reason, I would say if a person can tolerate metformin it would be reasonable with Zyprexa regardless of weight gain.

Having said that since you are new I'll remind everyone I'm not a doctor or anything like one.

<-----Read under my profile name.

 

[whopper]

Some people, actually the majority per studies, don't gain weight from it, but from my experience I'd say the majority gain weight.

 

[chajjohnson]

Some people, actually the majority per studies, don't gain weight from it, but from my experience I'd say the majority gain weight.

To be fair, the majority of people gain weight in general. I know Olanzapine causes more than placebo, but your individual patient's don't have placebo controls.

 

[whopper]

I'm not talking normal weight gain. I'm talking Olanzapine-induced weight gain where it's a few months later and they're dozens of pounds heavier.

 

[randomdoc1]

I've noticed with antipsychotics, even abilify, it seems the incidence of weight gain is higher than what is reported in the literature. Yes, people generally gain weight over time, antipsychotic or no antipsychotic, but abilify associated weight gain is something I've encountered which made the decision to stay on the medication tough. Found it quite helpful for augmentation but the metabolic SE doesn't help. As far as olanzapine, it seems like everyone I've put on it puts on weight and it just seems to continue, it doesn't really stop. Maybe the rate slows a little and I believe in the psychopharm lectures they've showed in my residency that literature says that's about right, the weight gain just sort of continues. Olanzapine does seem to induce metabolic changes independent of the weight gained. I've had a treatment resistant patient who also had diabetes, I put him on olanzapine and boom his diabetes went out of whack.

 

[futuredo32]

I've noticed with antipsychotics, even abilify, it seems the incidence of weight gain is higher than what is reported in the literature. Yes, people generally gain weight over time, antipsychotic or no antipsychotic, but abilify associated weight gain is something I've encountered which made the decision to stay on the medication tough. Found it quite helpful for augmentation but the metabolic SE doesn't help. As far as olanzapine, it seems like everyone I've put on it puts on weight and it just seems to continue, it doesn't really stop. Maybe the rate slows a little and I believe in the psychopharm lectures they've showed in my residency that literature says that's about right, the weight gain just sort of continues. Olanzapine does seem to induce metabolic changes independent of the weight gained. I've had a treatment resistant patient who also had diabetes, I put him on olanzapine and boom his diabetes went out of whack.

I have only seen people not gain weight on Geodon and Rexulti. Abilify was touted as a 5 lb weight gain, but I saw patients balloon out on that.

 

[whopper]

Abilify-when it first came out it was reported as not causing weight gain. Apparently it was an honest mistake. When meds complete phase III trials they are only tested on a few hundred people at most. If, say 2%, get weight gain and only a few hundred people are tested it's still very possible to miss it. When phase III trials end it enters what's called phase IV meaning that docs can prescribe it but it's still further studied cause obviously when meds have millions of people taking them you start noticing benefits and side effects not seen with the initial first few hundred.

When Abilify was in phase IV the bigger pool of data showed weight gain. It's still a better med to choose metabolically speaking. It's odds of causing weight gain are very small though some gain tremendous amounts of weight.

Another factor I want people to be aware of: If a medication can cause even tremendous amounts of weight don't necessarily freak out. It's not like the patient will gain 100 lbs overnight. If it happens it'll be slow and gradual. Stop it before it becomes the 150 lb gain the patient fears. Stop the med if the patient gains about 5 lbs in less than a month and/or if the patient c/o noticeable increases in appetite related to the medication.

The fact that the person gained tremendous amounts of weight is often an indicator that the patient has a poor clinician, the patient couldn't afford any other meds, or the patient tried other meds and this one that caused the weight gain was one of the only things that worked so the clinician and the patient had no choice. While I was a resident the only atypicals out there were Quetiapine, Risperidone, Olanzapine, and Clozapine. These days there's so many choices that if a clinician continues a med that causes tremendous weight gain there better be a good reason for it.

Back in my day if the patient gained a tremendous amount there really wasn't much of a better choice out there. Also to this day I still see idiot clinicians prescribe a med on some cockamamie notion that "it's my favorite med" or "psychiatry is an art and I'm an artist" bull$hit disregarding the vast amounts of data they could've tapped to be a better doctor but chose to be willfully ignorant.

 

[Merovinge]

Abilify-when it first came out it was reported as not causing weight gain. Apparently it was an honest mistake. When meds complete phase III trials they are only tested on a few hundred people at most. If, say 2%, get weight gain and only a few hundred people are tested it's still very possible to miss it. When phase III trials end it enters what's called phase IV meaning that docs can prescribe it but it's still further studied cause obviously when meds have millions of people taking them you start noticing benefits and side effects not seen with the initial first few hundred.

When Abilify was in phase IV the bigger pool of data showed weight gain. It's still a better med to choose metabolically speaking. It's odds of causing weight gain are very small though some gain tremendous amounts of weight.

Another factor I want people to be aware of: If a medication can cause even tremendous amounts of weight don't necessarily freak out. It's not like the patient will gain 100 lbs overnight. If it happens it'll be slow and gradual. Stop it before it becomes the 150 lb gain the patient fears. Stop the med if the patient gains about 5 lbs in less than a month and/or if the patient c/o noticeable increases in appetite related to the medication.

The fact that the person gained tremendous amounts of weight is often an indicator that the patient has a poor clinician, the patient couldn't afford any other meds, or the patient tried other meds and this one that caused the weight gain was one of the only things that worked so the clinician and the patient had no choice. While I was a resident the only atypicals out there were Quetiapine, Risperidone, Olanzapine, and Clozapine. These days there's so many choices that if a clinician continues a med that causes tremendous weight gain there better be a good reason for it.

Back in my day if the patient gained a tremendous amount there really wasn't much of a better choice out there. Also to this day I still see idiot clinicians prescribe a med on some cockamamie notion that "it's my favorite med" or "psychiatry is an art and I'm an artist" bull$hit disregarding the vast amounts of data they could've tapped to be a better doctor but chose to be willfully ignorant.

I put in a prior authorization to get a wt neutral atypical indicated for the specific condition (bipolar depression with psychosis) this patient had (Latuda), having failed Seroquel due to sedation/wt gain. Insurance said no way until they try risperidone... So sometimes its not just a lazy doctor, some of the privatized medicaid insurers can be completely ridiculous to deal with.

 

[PistolPete]

I put in a prior authorization to get a wt neutral atypical indicated for the specific condition (bipolar depression with psychosis) this patient had (Latuda), having failed Seroquel due to sedation/wt gain. Insurance said no way until they try risperidone... So sometimes its not just a lazy doctor, some of the privatized medicaid insurers can be completely ridiculous to deal with.

Unfortunately, this.

 

[whopper]

I've dealt with the same as well, which is why I mentioned sometimes the patient cannot afford anything else.

In my initial years of practice I hated use of Quetiapine. It was very much overprescribed, touted as treating "everything" and PCPs were giving it to people just for looking at them the wrong way, and remember this was when the med was still over $800 a month. Almost every patient I saw that couldn't sleep was prescribed it (by someone besides me) despite it's fantastically-then ridiculous price, and were never warned of the weight gain or told that at 50 mg it really wasn't more effective than OTC Diphenhydramine.

When CATIE came out at the end of my 3rd year, it put Quetapine in it's place. Largest amount of QT-prolongation, small efficacy for psychosis, and high-ratio of side effects compared to other meds. It was high side-effect, low efficacy for psychosis.

But with years of more experience and evidence-based data out there I have seen patients (a small minority) where it did cause benefits not obtainable with other meds. I still in-general don't make it 1st or even 3rd line but I have seen some patients very much benefit from it with Bipolar II Disorder and chronic depression as an augmentation agent where other meds didn't work.

What works for individual patients in highly individualized. Studies only tell us what happens with groups of people, but not that 1 person. So in general prioritize 1st line meds as the ones that work better and are cheaper, then correspondingly go down the list in terms of lesser effectiveness and higher cost.