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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by betternow on February 11, 2003, at 17:09:34
PsychEducation.org
metformin (Glucophage)
Updated December 2002
There are three reasons to read about this medication (at least):
It may block weight gain induced by psychiatric medications.
It may lead to weight loss for people who've experienced such weight gain.
It may actually treat some mental health symptoms.
Metformin was used recently as an "antidote" to weight gain induced by several different medications.Morrison It was remarkable effective in that one, small, uncontrolled (no placebo group) study -- meaning that these results should be interpreted with caution. Fifteen of the 19 patients lost weight, and some who continued metformin lost 10-30 pounds.There is more reason to be interested in this medication, however. A patient wrote me who had responded 20 years ago to the precursor of metformin (phenformin, removed from the market quickly because of risks which are fortunately much lower in metformin; see Lactic Acidosis below). She had "foggy mindedness" and difficulty concentrating which responded dramatically to phenformin. Note that she had "mental" symptoms, but was given a medication which affects insulin, and she got better. Her 3 children all had symptoms suggestive of Bipolar II, one diagnosed as such, and all 3 seemed to benefit from phenformin. Here's her letter, if you're interested (used by permission).
Her experience and that of her children illustrates how this medication may actually be a treatment in itself for complex mental health symptoms. For more on that possibility, read the essay on Metabolic Syndrome -- Causes Mental Health Symptoms?
Metformin is a medication given for the treatment of diabetes. Sometimes it is used for people who only have "insulin resistance". In this condition, people have difficulty responding to their own insulin. As a result, the body releases even more insulin trying to make up for this problem. However, insulin has many effects around the body.
One of these insulin effects may change a person's "metabolism" in very profound ways. Excess insulin can induce something called "metabolic syndrome". In younger women, this is sometimes recognized through infertility, or growing excess hair, and in that setting is called "Polycystic Ovarian Syndrome" (PCOS). Not everyone who has insulin resistance gets PCOS or metabolic syndrome, or diabetes – but many do.
Metformin can decrease this "insulin resistance". It can restore fertility. It can decrease excess hair growth and other body changes. In some cases this medication can decrease abdominal obesity, or at least assist people in their efforts to control their weight. In some people it can suppress appetite somewhat. It is now being tested for use with medications that commonly increase appetite and weight.
Risks
Metformin is associated with a problem called Lactic Acidosis (LA). In this condition the kidneys fail to clear out a normal product of muscle metabolism, lactate. LA occurs in roughly 5-9 people for every 100,000 treated; it has been fatal for half those affected, or roughly 2-5 deaths per 100,000.
However, since the relationship between with LA was discovered, several risk factors, noted below, have been discovered. Of the very few who've had metformin-associated LA with no risk factors, none have died.Misbin In other words, if people don't have these risk factors (below), there may be very low or even no risk of dying from taking this medication. There is even some debate as to whether metformin alone causes LA at all.Lalau But here are the risk factors to be aware of:
If you have congestive heart failure, or problems with your kidney function, you probably cannot take this medication. Your doctor will check your kidney function and liver function, which must both be O. K. before starting this medication. Using alcohol while taking this medication substantially increases the risk of having LA. Click for symptoms of lactic acidosis.
You should stop this medication if you have surgery, and begin taking it again when you are eating normal foods. Do not allow a contrast agent for a radiology procedure (e.g. a kidney test called an IVP) to be given while you are taking this medication; discuss how to handle any need for that test with your doctor.
Finally, some reports, but not all, caution against use of metformin along with certain medications that are handled by the kidney, called "cationic drugs".Calabrese, Klepser You should review your other medications with your doctor or pharmacist regarding this issue. Lithium might be among these, though there are no clear reports of problems with lithium and metformin together (manufacturer's database, consulted October 2002).
Side effects
If this medication very frequently causes diarrhea comments and sometimes nausea. You can try to decrease this problem by taking the medication only with meals. Using the generic metformin, you can cut the 500 mg pill in half when you first begin, which seems to help quite a bit. There is a "extended release" version, though this might cost you more; it does help limit these side effects, however. The XR version cannot be cut.
One of my experienced medicine colleagues says that taking the medication all at once with your largest meal, rather than spreading it out in smaller doses through the day, can decrease the diarrhea problem. The other trick she taught me: go up on the dose slowly, increasing by one pill (or even a half a pill) only every week or so. Most people can handle this medication if they go up slowly enough; faster, and you'll get diarrhea and sometimes nausea.
For other basic information, including other side effects -- which in my experience so far are not common -- see this summary from the National Library of Medicine (a great source regarding any medication).
How to start [updated Dec 2002]
The following information is what I tell my own patients. It is your responsibility to review this with your physician. Do not do this on your own. Your physician may have a different, perhaps better way of doing this.Generic 500mg pill
Start with 1/2 of a 500 mg pill once a day with meals. Increase by 1/2 pill steps every several weeks, once you're not having diarrhea! If you have trouble with nausea, or diarrhea, decrease to the previous dose and wait you're not having such symptoms before you try increasing again. Increase to a total of two 500 mg pills per day, which can be taken all at once with your largest meal of the day. From there we talk about how high to go.Trade-name extended release pills (Glucophage XR)
Start with one pill per day at your largest meal. Add 1 pill every several weeks. Take the first two at the same meal; after that, when adding the third pill, split the dose: one with one meal, two tablets with a bigger meal. Follow the same instructions above, decreasing the dose then increasing again, if you're having side effect problems. You may split the dose and take one pill with breakfast/lunch/dinner, if you get better results that way.The highest dose is usually one gram twice a day (two 500 mg pills in the morning, and two again in the evening, with meals). You'll probably be directed to keep increasing the dose until:
a) your symptoms are clearly responding;
b) you're getting an intolerable side effect (decrease to the previous dose);
c) you reach 1 gram twice a day.
Posted by Tina P on February 11, 2003, at 18:47:04
In reply to Zyprexa weight gain potential solution, posted by betternow on February 11, 2003, at 17:09:34
I am a type 1 diabetic female, age 30, on Effexor for depression. Unlike most type 1 diabetics, I am overweight. Doctors have referred to me as MODY or Mature Onset Diabetes in Youth, but only theoretically. I was diagnosed at age 19 immediately following hip surgery. Most of my life I struggled with 20 lbs or so, but in my 20's the weight just started to snowball. I've had eating disorders of all sorts, binging and purging most commonly. I am now needing to lose 60 lbs and getting nowhere since I gave birth in July 2002 for the first time (and probably the last) even with the use of Phentermine. In your opinion, am I a good candidiate for Glucophage? I have used it before for short periods of time, but found no results with my diabetes, so discontinued. Doctors who tried the drug on me would conclude that I am a Type 1 and have no use for it. I am now on the insulin pump for a few years, using only Humalog. I'm interested in our opinion on this. Thank you!
Posted by SLS on February 12, 2003, at 23:05:32
In reply to Re: Zyprexa weight gain potential solution, posted by Tina P on February 11, 2003, at 18:47:04
Hi.
I know of two people from opposite sides of the Atlantic who swear that adding amantadine (Symmetrel) to Zyprexa prevents weight-gain. It seems to be a more common practice in Sweden. If I need to use Zyprexa in the future, I will most definitely try it.
- Scott
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