Posted by Phillipa on October 31, 2008, at 19:36:39
Sorry thought this was important enough a study to post full abstrace as deals with a subject so many have. Phillipa forgive any advertisements.
mate Attenuate Psychotropic-Induced Weight Gain?
Posted 10/01/2008Darrell T. Hulisz, PharmD
Author Information
Efficacy of Add-on Topiramate Therapy in Psychiatric Patients With Weight Gain
Cates ME, Feldman JM, Boggs AA, Woolley TW, Whaley NP
Ann Pharmacother. 2008;42:505-510Study Summary
Cates and colleagues conducted a retrospective chart review at a community mental health clinic of 41 patients who had been prescribed topiramate for documented weight gain during stabilized treatment with psychotropic drugs.[1] A positive response was defined as weight loss of any magnitude from baseline to endpoint. Overall, the response rate was 58.5%, with mean reductions in weight of 2.2 kg. However, in those 24 patients who achieved a positive response, the mean weight loss was 7.2 kg, or an average 6.9% decrease from baseline.Heavier patients at baseline and those receiving a greater number of psychotropic drugs were more likely to experience greater weight loss with topiramate. Patients who responded favorably had a typical weight loss of 0.45-1.4 kg per month. Topiramate dosages were usually initiated at 50 mg/day, and the average maximum dose was 100 mg/day. Seven patients experienced adverse effects, mostly consisting of "cognitive dulling" and/or increased appetite.
Viewpoint
Weight gain is notoriously associated with psychotropic drugs, particularly atypical antipsychotic drugs (eg, olanzapine, clozapine, and risperidone). This study used a retrospective methodology similar to that reported by Khazaal and colleagues,[2] and the study authors reached a similar conclusion: Topiramate appears to be effective in reversing the weight gain that is associated with antipsychotic drugs.However, one important difference is that the average daily dose of topiramate reported in this study was about half that used in the Khazaal case series. In the latter study, 22% of patients discontinued use of topiramate because of side effects, compared with only 7.3% of patients in this study.
There are several limitations to this study, including those inherent to all retrospective chart reviews, namely, that data collection is limited to what is documented in patients' medical records. Other potential confounders exist, such as unknown medication adherence rates, differences in individual lifestyle modifications, fluctuations in weight gain, and the presence of other drugs known to induce weight gain, which was not reported.
Although this study suggested that topiramate is effective at attenuating weight gain associated with psychotropic drugs, I would prefer to see the results of a randomized, placebo-controlled trial. Controlling for these potential confounders is necessary to determine the magnitude of weight gain reversal associated with topiramate, as well as better defining the optimal dose and adverse reaction profile of the drug.
Abstrac Very small trial but interesting. Phillipa
poster:Phillipa
thread:860127
URL: http://www.dr-bob.org/babble/20081027/msgs/860127.html