Metformin for Atypical Antipsychotic-Induced Weight Gain and Glucose Metabolism Dysregulation

Abstract

Individuals receiving certain atypical antipsychotic medications are at risk of gaining weight and developing metabolic problems. There are no established drug treatments to prevent or counter these problems. However, the antihyperglycaemic agent metformin appears promising in some recent studies and we review the literature that evaluates metformin for limiting or reversing atypical antipsychotic drug-induced weight gain and glucose metabolism dysregulation. These studies suggest that metformin is beneficial if started early in antipsychotic drug treatment. Metformin has also been shown to prevent or delay the onset of type 2 diabetes mellitus in high-risk individuals from the general population. Based on these findings, we identify antipsychotic drug-treated patients who might benefit from metformin therapy and offer clinical guidelines for its use. Further long-term studies are needed to extend our observations and improve this strategy.

Metformin for Weight Gain and Metabolic Abnormalities Associated With Antipsychotic Treatment

“…This is consistent with our findings. There were a few reviews focused on metabolic parameters other than weight gain, 6,14,64 such as glucose and cholesterol, which indicated that metformin may have some benefit in metabolic parameters. That was also consistent with our findings.…”

“…[5][6][7][8][9][10][11][12] Among them, metformin stands out as particularly promising, as it promotes moderate weight loss and improves glycemic control in both diabetic and nondiabetic patients. [13][14][15][16][17][18][19][20][21][22] Compared with previously published metformin reviews or meta-analyses on antipsychotic-induced weight gain, [13][14][15][16][17][18][19][20][21][22] this new meta-analysis includes all published articles in both the English and Chinese languages and focuses on all metabolic ADRs and all antipsychotics.…”

Metabolic and Cardiovascular Adverse Effects Associated with Treatment with Antipsychotic Drugs

“…53 Metformin is an oral antihyperglycemic agent used to treat noninsulin-dependent diabetes mellitus. It reduces blood glucose levels, predominantly by improving insulin sensitivity in the hepatic and peripheral tissues without affecting the secretion of insulin.…”

Metformin may be useful in managing atypical antipsychotic-induced metabolic problems

“…[4] For some atypical antipsychotics, adiposity is not the sole reason for their diabetogenic potential. [4] For some atypical antipsychotics, adiposity is not the sole reason for their diabetogenic potential.…”

“…[4] For some atypical antipsychotics, adiposity is not the sole reason for their diabetogenic potential. [4] Pancreatic b-cell responsiveness may be lessened by antipsychotic antagonism of muscarinic M 3 and 5-HT 1A receptors, and glucose uptake in skeletal muscle may be suppressed by antagonism of the 5-HT 2A receptor. [4] Pancreatic b-cell responsiveness may be lessened by antipsychotic antagonism of muscarinic M 3 and 5-HT 1A receptors, and glucose uptake in skeletal muscle may be suppressed by antagonism of the 5-HT 2A receptor.…”