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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by SLS on October 21, 2000, at 12:09:30
My thanks to Anita for being so smart...
- Scott
------------------------------------------------
Nizatidine for Olanzapine Weight GainA common consequence of olanzapine therapy is weight gain. After observing unexpected weight loss in 2 olanzapine-treated patients with schizophrenia, concurrently taking the H2 antagonist nizatidine for peptic esophagitis, the authors elected to use nizatidine in a patient whose olanzapine-associated obesity was particularly burdensome.
A 23-year-old man with paranoid schizophrenia (DSM-IV) responded well to olanzapine but elected to stop taking the medication after a 26-lb weight gain. Ten months later, his weight had returned to baseline but his psychotic symptoms relapsed. Four weeks after restarting olanzapine, he had gained 14 lb and again wanted to stop the olanzapine, despite improvement of his psychotic symptoms. Four weeks after adding 150 mg nizatidine b.i.d. to olanzapine, his weight was unchanged; 4 weeks later, he had lost 9 lb. His weight loss was maintained during the following 2 months of observation.
Although the mechanism is unknown, various published reports have suggested that the H2 receptor antagonist cimetidine can induce weight loss in overweight persons. Controlled trials are needed to learn whether concurrent administration of an H2 antagonist, such as nizatidine, can prevent and/or control olanzapine-associated weight gain.
Sacchetti E, Guarneri L, Bravi D: H2 antagonist nizatidine may control olanzapine-associated weight gain in schizophrenic patients. Biological Psychiatry 2000;48 (July 15):167–168. From University School of Medicine and Spedali Civili, Brescia, Italy; and Eli Lilly & Co, Florence.
Drug Trade Names: cimetidine—Tagamet; nizatidine—Axid; olanzapine—Zyprexa
Posted by Greg on October 21, 2000, at 16:17:07
In reply to Nizatidine for Zyprexa (olanzapine) Weight Gain , posted by SLS on October 21, 2000, at 12:09:30
Hey Scott,
Thanks for posting this. I started Zyprexa 10 days ago. Great results! I have put on a couple of pounds, but I haven't noticed any increase in appetite. If anything I don't seem to feel as hungry. I do notice that more often than not, I get bloated when I eat.
I was wondering if possibly the Zy is causing an increased level of fat retention in the foods I eat? I've heard that some drugs can do that. Do you have any thoughts along this line?
Greg
> My thanks to Anita for being so smart...
>
>
> - Scott
>
>
> ------------------------------------------------
>
>
> Nizatidine for Olanzapine Weight Gain
>
> A common consequence of olanzapine therapy is weight gain. After observing unexpected weight loss in 2 olanzapine-treated patients with schizophrenia, concurrently taking the H2 antagonist nizatidine for peptic esophagitis, the authors elected to use nizatidine in a patient whose olanzapine-associated obesity was particularly burdensome.
>
> A 23-year-old man with paranoid schizophrenia (DSM-IV) responded well to olanzapine but elected to stop taking the medication after a 26-lb weight gain. Ten months later, his weight had returned to baseline but his psychotic symptoms relapsed. Four weeks after restarting olanzapine, he had gained 14 lb and again wanted to stop the olanzapine, despite improvement of his psychotic symptoms. Four weeks after adding 150 mg nizatidine b.i.d. to olanzapine, his weight was unchanged; 4 weeks later, he had lost 9 lb. His weight loss was maintained during the following 2 months of observation.
>
> Although the mechanism is unknown, various published reports have suggested that the H2 receptor antagonist cimetidine can induce weight loss in overweight persons. Controlled trials are needed to learn whether concurrent administration of an H2 antagonist, such as nizatidine, can prevent and/or control olanzapine-associated weight gain.
>
> Sacchetti E, Guarneri L, Bravi D: H2 antagonist nizatidine may control olanzapine-associated weight gain in schizophrenic patients. Biological Psychiatry 2000;48 (July 15):167–168. From University School of Medicine and Spedali Civili, Brescia, Italy; and Eli Lilly & Co, Florence.
>
> Drug Trade Names: cimetidine—Tagamet; nizatidine—Axid; olanzapine—Zyprexa
Posted by SLS on October 21, 2000, at 18:10:48
In reply to Re: Nizatidine for Zyprexa (olanzapine) Weight Gain » SLS, posted by Greg on October 21, 2000, at 16:17:07
Hi Greg.
> Thanks for posting this. I started Zyprexa 10 days ago. Great results! I have put on a couple of pounds, but I haven't noticed any increase in appetite. If anything I don't seem to feel as hungry. I do notice that more often than not, I get bloated when I eat.
I'm glad to hear that Zyprexa has you feeling so much better.
How has Zyprexa helped you? Did you use it to treat depression?
How much are you taking? What other drugs are you taking?I suffer from bipolar depression. I am currently taking an MAO-inhibitor to which I am probably going to add either Zyprexa or Risperdal. It would be helpful to me to know more about your situation to make a decision between these two drugs.
> I was wondering if possibly the Zy is causing an increased level of fat retention in the foods I eat? I've heard that some drugs can do that. Do you have any thoughts along this line?
I think this is an excellent way of looking at it.
I am not very knowledgeable regarding the reasons why drugs produce weight gain. What I can say is that a drug can produce changes in how the body manages energy independent of food intake. There are several different ways in which a drug can do this. A lot of drugs produce weight-gain by blocking H1 histamine receptors. Remeron is an example of this. Other drugs produce increases in the secretion of a hormone called prolactin. One of the functions of prolactin is to encourage the body to deposit and retain fat. Zyprexa does both. It blocks H1 histamine receptors and increases prolactin levels. Double-whammie. I wish I had a clue as to why some people gain weight on SSRIs. I believe that increased prolactin may be involved in a subgroup of individuals. However, I can't seem to find anything that addresses the exact mechanisms behind this side effect.
It is not necessary to eat fat to gain fat. The body can use sugar to manufacture its own fat. It is not so much how the body processes the fat in the foods you eat as it is how the entire system is regulated to manage energy utilization.
I hope someone can amplify and correct what I have said here.
- Scott
Posted by Lin on October 21, 2000, at 19:26:00
In reply to Re: Nizatidine for Zyprexa (olanzapine) Weight Gain , posted by SLS on October 21, 2000, at 18:10:48
Scott,
I too have bipolar illness and I have been on Risperdal and Zyprexa. Of the two, I find Zyprexa FAR FAR more effective. In addition to its mood stabilizing properties, it is a powerful anti-anxiety med and it has really quieted the inner agitation that tortured me for years. I have gained weight on it, though, which for me isn't too tragic since I am pretty thin to start with. The only other side effect I have had is tiredness, but this went away several weeks after starting the med. On Risperdal, I didn't gain any weight, but I also did not notice any change in my symptoms. With Zyprexa, the agitation of hypomanias and mood swings is removed. It is as if something just unfolds inside of me. Good luck with your meds and let me know if you want any more info/input.Lin
Posted by SLS on October 21, 2000, at 20:25:10
In reply to Re: Nizatidine for Zyprexa (olanzapine) Weight Gain » SLS, posted by Lin on October 21, 2000, at 19:26:00
> Scott,
> I too have bipolar illness and I have been on Risperdal and Zyprexa. Of the two, I find Zyprexa FAR FAR more effective. In addition to its mood stabilizing properties, it is a powerful anti-anxiety med and it has really quieted the inner agitation that tortured me for years. I have gained weight on it, though, which for me isn't too tragic since I am pretty thin to start with. The only other side effect I have had is tiredness, but this went away several weeks after starting the med. On Risperdal, I didn't gain any weight, but I also did not notice any change in my symptoms. With Zyprexa, the agitation of hypomanias and mood swings is removed. It is as if something just unfolds inside of me. Good luck with your meds and let me know if you want any more info/input.
>
> Lin
Dear Lin,Thank you so, so much for your input. I really do appreciate it.
I guess my main question is whether or not you feel Zyprexa can help with severe depression. I don't have problems with mania, unless it is produced by drug treatment. I would be using Zyprexa as an antidepressant more than an antimanic.
I think Zyprexa is an *excellent* drug. I am so happy that you are doing well on it. How different life can be, right? :-)
Enjoy.
Thanks again.
- Scott
Posted by Cam W. on October 22, 2000, at 11:52:27
In reply to Nizatidine for Zyprexa (olanzapine) Weight Gain , posted by SLS on October 21, 2000, at 12:09:30
Scott - The jury is still out on the Axid preventing Zyprexa-induced weight gain. Most of the docs I know have tried it and don't believe it. We have one doc in town who really thinks it does work (according to the Lilly rep). If it does work, you should notice that the weight gain hasn't started in the first 8 weeks. This doc says that he has had good results (approx. 20% don't gain weight), but I don't know if he took into account those that do have a good response to Zyprexa and do not gain gain weight.
I know it sounds hard to believe, but I have seen several people not gain weight on Zyprexa and also have a decrease in psychotic symptoms. I do not know of any reasons why this is so, but it does happen. I am sure that in both the Zyprexa-induced weight gain and non-weight gain groups, there are patient-dependent variables that have not been considered.
I was at a lecture a year or so ago and the presenter stated the same results with cimetidine (Tagamet™ - same family as Axid™). I cornered him afterward for an explanation. He told me that this was the info the company (Lilly) had given him. I asked the rep and he hadn't heard of it. I talked to some of the "Doogies" (read pyschiatry residents), as well as some of the docs and we came up with a couple of hypotheses.
1) Something weird is happening at the H1 receptor. Tagamet and Axid are H2 receptor blockers. Blocking H1 (as seen with antihistamines) causes weight gain. I don't think that Tagamet stimulates H1 receptors to cause weight loss, though.
2) Tagamet is a "dirty" drug. It binds to all sorts of other receptors in the body. Could it be the binding to these other receptors that prevents weight gain? Axid is a cleaner drug, so this makes the "dirty" drug theory even less probable.Also, I believe that Toby made a similar claim a couple of years ago and used Dr.S.Stahl as a reference. Stahl wrote back to Dr.Bob claiming that he didn't make this claim and saw no reason why it would work, and Dr.B. relayed the info to PB.
A couple of cents - Cam
Posted by Cam W. on October 22, 2000, at 12:04:03
In reply to Re: H2 Antagonists for Weight Gain , posted by Cam W. on October 22, 2000, at 12:01:21
Scott - I found the posting from Stahl. It was in regard to Remeron (mirtazapine), though.
http://www.dr-bob.org/babble/19990829/msgs/10921.html
- Cam
You'd think I'd be able to make those underliney thingys the first try!Or even a SECOND try!
Dr.Bob - You can erase the 2 previous posts (sigh).
Posted by Greg on October 22, 2000, at 14:29:24
In reply to Re: Nizatidine for Zyprexa (olanzapine) Weight Gain , posted by SLS on October 21, 2000, at 18:10:48
> Hi Greg.
>
> > Thanks for posting this. I started Zyprexa 10 days ago. Great results! I have put on a couple of pounds, but I haven't noticed any increase in appetite. If anything I don't seem to feel as hungry. I do notice that more often than not, I get bloated when I eat.
>
> I'm glad to hear that Zyprexa has you feeling so much better.
>
> How has Zyprexa helped you? Did you use it to treat depression?
> How much are you taking? What other drugs are you taking?The Zyprexa has made feel calmer and more relaxed. Probably the biggest benefit for me is the quieting of my "committee". My mind is quiet. I think about the things I want to think about and not flooded with 20 thoughts at the same time. I use it to treat Bipolar II. I take 2.5 mgs per day (bedtime). I also take Neurontin, 900 mgs per day. One of the unexpected benefits for me is that I haven't had a single depressive "episode" in 12 days. This has been a miracle med for me! Can't say it will work for you of course, but I've heard much more on the positive side from others about than the negative. If you try it, please let me know how it works for you.
>
> I suffer from bipolar depression. I am currently taking an MAO-inhibitor to which I am probably going to add either Zyprexa or Risperdal. It would be helpful to me to know more about your situation to make a decision between these two drugs.
>
> > I was wondering if possibly the Zy is causing an increased level of fat retention in the foods I eat? I've heard that some drugs can do that. Do you have any thoughts along this line?
>
> I think this is an excellent way of looking at it.
>
> I am not very knowledgeable regarding the reasons why drugs produce weight gain. What I can say is that a drug can produce changes in how the body manages energy independent of food intake. There are several different ways in which a drug can do this. A lot of drugs produce weight-gain by blocking H1 histamine receptors. Remeron is an example of this. Other drugs produce increases in the secretion of a hormone called prolactin. One of the functions of prolactin is to encourage the body to deposit and retain fat. Zyprexa does both. It blocks H1 histamine receptors and increases prolactin levels. Double-whammie. I wish I had a clue as to why some people gain weight on SSRIs. I believe that increased prolactin may be involved in a subgroup of individuals. However, I can't seem to find anything that addresses the exact mechanisms behind this side effect.
>
> It is not necessary to eat fat to gain fat. The body can use sugar to manufacture its own fat. It is not so much how the body processes the fat in the foods you eat as it is how the entire system is regulated to manage energy utilization.
>
> I hope someone can amplify and correct what I have said here.
>
>
>
> - Scott
Posted by Sassy on October 24, 2000, at 15:16:37
In reply to Re: H2 Antagonists for Weight Gain - Stahl Reply » Cam W., posted by Cam W. on October 22, 2000, at 12:04:03
Hi everyone,
After reading the associated post on the subject of weight gain, I need some help.
My situation is I'm giving effexor one more shot
because it really took the cloud away in depression. It was the only med that has done this. Prozac is second best, but not like effexor. I took 150 mg 3 X time. Over several months I gained 50 pounds. During this period I increased the dosege or effexor, used it with remeron, later used it with wellbrutin and then all by itself. (I lost 25 pounds after I stopped). During a second round, I used it with topomax and zanac. The weight started coming back. I'm trying it one more time, closely monitoring the results.Effexor does give me cravings for fats and carbos, but not out of control like remeron which I take occasionally (once a month) if I need to sleep 15 mg). Effexor makes my stomach and intestinal tract fill out with gas like a GIANT water hose (and the gas comes out like that if I don't hold it in). I am looking for the answer on what counteracts this. Do I want an H2 antagonist. What is an antagonist versus a blocker? I'm confused and this topomax sure isn't helping. I take the topomax to counteract the weight loss, so far it may be slowing down the weight gain. What is the theory that causes the weight gain and these systems. I've read so much that I'm really confused.
Sassy
> Scott - I found the posting from Stahl. It was in regard to Remeron (mirtazapine), though.
>
> http://www.dr-bob.org/babble/19990829/msgs/10921.html
>
> - Cam
>
> You'd think I'd be able to make those underliney thingys the first try!
>
> Or even a SECOND try!
>
> Dr.Bob - You can erase the 2 previous posts (sigh).
Posted by Sassy on October 31, 2000, at 16:09:39
In reply to Re: EXPERTS HELP ME, posted by Sassy on October 24, 2000, at 15:16:37
Dr.Bob,
Do you have any suggestions.
Sassy
> Hi everyone,
>
> After reading the associated post on the subject of weight gain, I need some help.
>
> My situation is I'm giving effexor one more shot
> because it really took the cloud away in depression. It was the only med that has done this. Prozac is second best, but not like effexor. I took 150 mg 3 X time. Over several months I gained 50 pounds. During this period I increased the dosege or effexor, used it with remeron, later used it with wellbrutin and then all by itself. (I lost 25 pounds after I stopped). During a second round, I used it with topomax and zanac. The weight started coming back. I'm trying it one more time, closely monitoring the results.
>
> Effexor does give me cravings for fats and carbos, but not out of control like remeron which I take occasionally (once a month) if I need to sleep 15 mg). Effexor makes my stomach and intestinal tract fill out with gas like a GIANT water hose (and the gas comes out like that if I don't hold it in). I am looking for the answer on what counteracts this. Do I want an H2 antagonist. What is an antagonist versus a blocker? I'm confused and this topomax sure isn't helping. I take the topomax to counteract the weight loss, so far it may be slowing down the weight gain. What is the theory that causes the weight gain and these systems. I've read so much that I'm really confused.
>
> Sassy
> > Scott - I found the posting from Stahl. It was in regard to Remeron (mirtazapine), though.
> >
> > http://www.dr-bob.org/babble/19990829/msgs/10921.html
> >
> > - Cam
> >
> > You'd think I'd be able to make those underliney thingys the first try!
> >
> > Or even a SECOND try!
> >
> > Dr.Bob - You can erase the 2 previous posts (sigh).
Posted by Cam W. on November 1, 2000, at 19:24:15
In reply to Correction to above post » Cam W., posted by Cam W. on November 1, 2000, at 19:07:29
••Dr.Bob - As a favor to me, could you delete my previous 2 posts - Thanks, Cam••
Oops #2 - desensitizing, not stimulaing 5-HT2C receptors
•AMENDED VERSION 2•Sassy - H2-receptor antagonists (aka H2- recptor blockers) may work to decrease weight gain by some unknown mechanism, but I haven't personally seen it work. There are anecdotal reports (aka letters to the editor) of cimetidine (Tagamet™) and nizatidine (Axid™) working to stop the weight gain from occuring, but is not used in weight loss (I think).
As for the theories of serotonergic antidepressants (SSRIs, Remeron™, Serzone™) causing weight gain. There are probably several events occuring. The increased serotonin is probably desensitizing serotonin-2C receptors (5-HT2C), which has been shown to increase weight. I believe that Remeron blocks histamine (H-1) receptors which also causes weight gain. People often mention a craving for carbohydrates. There are other theories, but I can't think of them right now. I know that Clozaril™ (clozapine) and Zyprexa™ (olanzapine) can cause increased levels of leptin in the plasma, which is also implicated in weight gain. I'm not sure if leptin levels are raised with serotonergic antidepressant use.
Keeping a food diary (of what you are eating) and trying to eat healthier (I'm one to talk) and moderate daily exercise can help shift some of that weight around (lose fat & gain muscle).
Hope this helps - Cam
(Man, I think I'll quit while I'm way behind.)
Posted by Sassy on November 1, 2000, at 19:26:11
In reply to Correction to above post » Cam W., posted by Cam W. on November 1, 2000, at 19:07:29
CAM,
You've probably been repeating the same information to someone else someplace else
in the site. Thank you for the information.I do try to spend as much time researching, but but with the time I do, don't feel I'm getting anywhere. I tell you, sometimes trying to get use to these drugs, when you have to really think, you realize how much your mind is messed up. That's a feeling I hate, and to be honest, time I can't afford.
This search gets frustrating sometimes, but I always seem to come back and try again. I do see others are going through the same thing. Hope we strike oil soon.
Thanks again,
Sassy> •Oops, looked down at the journal article beside me. It is the serotonin-2C (5-HT2C) receptor that is implicated in weight gain, not the 5-HT3 receptor (stimulation of that receptor causes tummy upset).•
>
> •AMENDED VERSION•
>
> Sassy - H2-receptor antagonists (aka H2- recptor blockers) may work to decrease weight gain by some unknown mechanism, but I haven't personally seen it work. There are anecdotal reports (aka letters to the editor) of cimetidine (Tagamet™) and nizatidine (Axid™) working to stop the weight gain from occuring, but is not used in weight loss (I think).
>
> As for the theories of serotonergic antidepressants (SSRIs, Remeron™, Serzone™) causing weight gain. There are probably several events occuring. The increased serotonin is probably stimulating serotonin-2C receptors (5-HT2C), which has been shown to increase weight. I believe that Remeron blocks histamine (H-1) receptors which also causes weight gain. People often mention a craving for carbohydrates. There are other theories, but I can't think of them right now. I know that Clozaril™ (clozapine) and Zyprexa™ (olanzapine) can cause increased levels of leptin in the plasma, which is also implicated in weight gain. I'm not sure if leptin levels are raised with serotonergic antidepressant use.
>
> Keeping a food diary (of what you are eating) and trying to eat healthier (I'm one to talk) and moderate daily exercise can help shift some of that weight around (lose fat & gain muscle).
>
> Hope this helps - Cam
This is the end of the thread.
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