Dramatic weight loss associated with commencing clozapine

Lally, John; McDonald, Colm

doi:10.1136/bcr.09.2011.4790

Cited by 5 publications

(5 citation statements)

References 13 publications

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“…They hypothesised that improvement in negative symptoms was the main drive behind loss of weight 21. This line of reason was emphasised in the case reported by Lally and McDonald22 when significant improvement in motivation and engagement in regular exercise were produced about by initiation on clozapine. They noted a subsequent striking drop in BMI from 41.5 to 24.8 kg/m 2 .…”

Section: Discussionmentioning

confidence: 96%

Clozapine-induced dysphagia with secondary substantial weight loss

Osman¹,

Devadas

2016

BMJ Case Reports

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Dysphagia is listed as a 'rare' side effect following clozapine treatment. In this case report, we describe how significant clozapine-induced dysphagia has led to significant reduction of nutritional intake with subsequent substantial weight loss. An 18-year-old single man with an established diagnosis of treatment-resistant paranoid schizophrenia recovered well on a therapeutic dose of clozapine. However, he was noted to lose weight significantly (up to 20% of his original weight) as the dose was uptitrated. This was brought about by development of dysphagia, likely to be due to clozapine. Addition of nutritional supplementary liquids and initiation of a modified behavioural dietary/swallowing programme, while repeatedly mastering the Mendelsohn manoeuvre technique, alleviated the swallowing difficulties and restored his weight.

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Section: Discussionmentioning

confidence: 96%

Clozapine-induced dysphagia with secondary substantial weight loss

Osman¹,

Devadas

2016

BMJ Case Reports

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“…It is also possible that the decline in HbA1c levels observed in the present study was due to cognitive improvements. For example, CLZ treatment has shown an association with weight loss (Thomas et al 2009;Hanwella et al 2010;Appiani et al 2011;Lally and McDonald 2011;Webster and Ingram 2013;Tungaraza 2016) and some case reports have indicated that improvements in cognitive func-tion due to CLZ treatment increased patients' interest in diet and exercise, which resulted in decreased body weight (Appiani et al 2011;Lally and McDonald 2011). Because psychopathologies and cognitive function were not evaluated in the present study, further studies will be necessary to clarify the correlations between improvements in psychotic symptoms and/or cognitive function and HbA1c levels after the initiation of CLZ.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors Associated with New-Onset Glucose Intolerance among Patients with Schizophrenia during Clozapine Treatment: All-Case Surveillance in Japan

Ishibashi

Matsui

Kawano³

et al. 2020

Tohoku J. Exp. Med.

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Clozapine (CLZ), an antipsychotic with a unique mechanism of action, is known to be superior to any other antipsychotic for schizophrenia. However, CLZ is also known to be associated with the development of lethal side effects, which include agranulocytosis and glucose intolerance (GI). Regular measurement and registration of blood test results have been mandatory for all CLZ users; however, these risks may still prevent therapists from prescribing CLZ. While CLZ-induced agranulocytosis has been well documented, CLZ-induced GI in the real world has not been fully investigated. Therefore, in this study, we used data registered in monitoring systems to investigate background factors associated with new-onset GI after CLZ administration and changes in HbA1c levels during CLZ treatment. Data of all patients with schizophrenia who were using CLZ from July 29, 2009 to January 20, 2016 were used for the analysis. Of the 3,746 patients enrolled in the study, 92 (2.5%) had GI at baseline; of the remaining 3,654 patients, 428 (11.7%) developed new-onset GI. Multivariate logistic regression analysis revealed that the development of new-onset GI was significantly associated with older age, higher baseline HbA1c levels, and longer treatment duration. In patients with GI at baseline, HbA1c levels were maintained or improved over 18 months, while in the other patients, CLZ administration gradually elevated HbA1c levels. The findings of this study suggest that, although adequate monitoring and intervention is required, CLZ induction and maintenance therapy may be safe, even for patients with impaired glucose tolerance.

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“…The explanation given as to the cause of weight loss varied between cases. In three cases [Lally and McDonald, 2011; Appiani et al , 2011; Webster and Ingram, 2013], weight loss was as a result of improved mental state, better side-effect management and engagement in diet and exercise. In the three cases reported by Hanwella and colleagues, weight loss was attributable purely to taking clozapine [Hanwella et al .…”

Section: Discussionmentioning

confidence: 99%

“…Management of antipsychotic-induced weight needs to include a number of strands such as lifestyle changes, cognitive behavioural therapy, change to antipsychotics that are less likely to cause weight gain and adding compounds known to induce weight loss [Kwon et al 2006; Khazaal et al 2007; Raja, 2011; Werneke et al 2013]. Lifestyle modification was possible in two cases [Lally and McDonald. 2011; Appiani, 2011].…”

Section: Weight Managementmentioning

confidence: 99%

Significant weight loss following clozapine use, how is it possible? A case report and review of published cases and literature relevant to the subject

Tungaraza¹

2016

Therapeutic Advances in Psychopharmacology

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It has been repeatedly shown that clozapine is more efficacious than other antipsychotics in the management of treatment-resistant schizophrenia. However, clozapine is associated with a number of side effects including weight gain. Antipsychotic-induced weight gain has been linked with a number of untoward events including psychological factors such as stigma and low self-esteem, and physical factors such as metabolic syndromes and untimely death. The mechanism underlying antipsychotic (including clozapine)-induced weight gain is not clearly understood, although it is said to involve several brain areas, several neurotransmitters, neuropeptides and genetic factors. To some individuals however, clozapine use is associated with significant weight loss (13.5-50% of body weight). The observed weight loss in these groups of patients has not been attributed to any underlying diagnosable physical disorders. There have been a handful cases published with this phenomenon, which seems to be contrary to what is expected when clozapine is prescribed. From the currently published cases three groups emerge - those who lost weight simply by taking clozapine, those who lost weight due to improved mental state, engaging in diet and increased exercise, and those for whom weight loss was a sign of a poor response to clozapine. A case of JX who has a diagnosis of schizoaffective disorder is presented. JX lost over 26% of her body weight when she was prescribed clozapine. A detailed review of other published cases is undertaken. The underlying mechanisms involving weight loss are discussed and the implications to clinicians are highlighted. Coordinated studies to examine these groups of patients may provide some insight, not only in the mechanism of clozapine-induced weight loss, but also in the better management of patients with treatment-resistant schizophrenia involving clozapine use.

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Dramatic weight loss associated with commencing clozapine

Cited by 5 publications

References 13 publications

Clozapine-induced dysphagia with secondary substantial weight loss

Clozapine-induced dysphagia with secondary substantial weight loss

Clinical Factors Associated with New-Onset Glucose Intolerance among Patients with Schizophrenia during Clozapine Treatment: All-Case Surveillance in Japan

Significant weight loss following clozapine use, how is it possible? A case report and review of published cases and literature relevant to the subject

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