The role of metformin and topiramate in reducing the side effects due to antipsychotics in patients with schizophrenia

Abstract

It is known that the patients with schizophrenia have a shorter life span than their healthy peers. Increased risk for cardiovascular disease is the most important contributor. There is a relationship between cardiovascular diseases and obesity, smoking, diabetes, dyslipidemia and hypertension. Antipsychotics cause obesity and dyslipidemia. The rate of 7% increase from baseline weight was reported as 30% in those who were taking olanzapine, 16% in those taking quetiapine, 14% in risperidone group, 12% in perphenazine group and 7% in ziprasidone group in CATIE study. Changing lifestyle, switching antipsychotic to another one or additional use of a medicine which helps to lose weight might be recommended to prevent weight gain due to antipsychotics in patients with schizophrenia. It has been shown that an antidiabetic agent, metformine is an effective treatment option in nondiabetic obese individuals. Metformin was reported as effective in reducing weight gain due to antipsychotics, fasting glucose level, insulin level, insulin resistance and amenorrhea due to antipsychotics. Topiramate, an antiepileptic agent was reported to use reducing weight gain as well. In this review, we will address the mechanisms action to prevent weight gain due to antipsychotics and dosing of metformin and topiramate.