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Re: Amantadine anyone?

Posted by Rosy Crucifiction on October 27, 2009, at 12:39:41

In reply to Amantadine anyone?, posted by uncouth on October 27, 2009, at 11:11:43

Sounds reasonable based on the study below. IMHO the meds issues are more often about side effects than efficacy. I would just be cautious you're not trading one bad set of side effects for another.
Metformin seems more benign, but maybe less effective. Adding naltrexone would recreate the forthcoming weight loss drug Contrave.

BTW- off the subject, when I've taken selegiline with Wellbutrin I've gotten fairly nasty BP spikes and edginess. How does it effect you?

Anyway, a study on amantadine for zyprexa, and a doctor's take on the issue follows:

Double-Blind, Placebo-Controlled Investigation of Amantadine for Weight Loss in Subjects Who Gained Weight With Olanzapine
Karen A. Graham, M.Sc., M.D., Hongbin Gu, Ph.D., Jeffrey A. Lieberman, M.D., Joyce B. Harp, M.D., and Diana O. Perkins, M.D., M.P.H.

OBJECTIVE: This study sought to determine if amantadine affects weight gain in psychiatric patients taking olanzapine. METHOD: Twenty-one adults who had gained at least 5 lb with olanzapine were randomly assigned to receive amantadine (N=12) or placebo (N=9) in addition to olanzapine. The length of time taking olanzapine ranged from 1 to 44 months. Body mass index, psychiatric status, and fasting blood levels were assessed at baseline and 12 weeks. RESULTS: Significantly fewer subjects taking amantadine gained weight, with a mean change in body mass index of 0.07 kg/m2 for the amantadine group and 1.24 kg/m2 for the placebo group. This effect remained significant when the authors controlled for baseline body mass index and length of olanzapine treatment. No changes in fasting glucose, insulin, leptin, prolactin, and lipid levels were seen. Positive and Negative Syndrome Scale scores remained stable. CONCLUSIONS: Amantadine induced weight stabilization in subjects taking olanzapine and was well tolerated.

" person on amantadine (out of 12) dropped out because he or she became psychotic. This is a recognized risk of using amantadine in this setting.

I have tried this approach in three patients. It stopped weight gain in all three but none are still on it. Tremor was the main reason for stopping. For now, until further research is published, amantadine just doesn't seem worth the risk to me, so I am not routinely offering it. Indeed, I try to use some medication other than Zyprexa to avoid this situation. But I must admit, it's extremely effective. I would continue to consider amantadine if for some reason my patient really needed to stay on Zyprexa -- especially if they'd never had an episode of psychosis before. "

"A possible new entry in the "antidote" group is Glucophage (metformin). We have much less experience with this medication in this role, but tons of experience with it overall -- it's been a standard medication for diabetes for years. It does not lower blood sugar directly, so lowering your blood sugar "too far" using this medication is not a problem. It directly reverses on of the possible ways that Depakote and Zyprexa cause weight gain, through something called "metabolic syndrome". Too bad Glucophage is a little tricky to use: it causes diarrhea in about 50% of people who take it, although if you start low enough and go up slowly enough you are much more likely to avoid this problem.

However, there is one small "open trial" (no control group) which showed that adding Glucophage to Zyprexa, or Depakote, or Risperidone, was enough to cause 15 of the 19 kids who had gained weight on those agents to start losing weight.Morrison In most of the kids it was a substantial and sustained weight loss. And there's perhaps -- just perhaps -- one more reason to think that this "antidote" strategy with Glucophage might be a good thing."

He goes on to note, though, that in clinical experience metformin hasn't been that effective for everyone. It does have the benefit of having potential life extending effects though. (see




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