Cates Marshall E, Feldman Jacqueline M, Boggs Angela A, Woolley Thomas W, Whaley Nanci P
McWhorter School of Pharmacy, Samford University, Birmingham, AL 35229, USA.
Ann Pharmacother. 2008 Apr;42(4):505-10. doi: 10.1345/aph.1K520. Epub 2008 Mar 25.
Weight gain is a common adverse effect of many psychotropic medications including antipsychotics, antidepressants, and mood stabilizers. There is a growing body of evidence that topiramate may be useful as an add-on therapy to induce weight loss in patients who have experienced psychotropic-induced weight gain.
To determine the efficacy and tolerability of topiramate for treatment of weight gain in a naturalistic mental health clinic setting.
A retrospective chart review was conducted at a community mental health clinic. Subjects were non-elderly adults who received topiramate therapy beginning in 2002-2005 for documented weight gain during treatment with psychotropic drugs. Primary outcome measures included response rate (based on weight loss of any magnitude) and mean changes in weight and body mass index (BMI).
Forty-one patients were included in the study. There was a 58.5% (n = 24) response rate. Mean reductions in weight and BMI were approximately 2.2 kg and 0.5 points, respectively. Responders lost an average of 7.2 kg, whereas nonresponders gained an average of 5.0 kg. Patients with a baseline weight of at least 91 kg and those receiving a greater number of psychotropic medications were more likely to experience success with topiramate therapy. Of the 24 patients who responded to therapy, 22 experienced onset of weight reduction by the next clinic visit (1-4 mo) following either initiation of therapy or titration to the eventual therapeutic dose, and the usual rate of weight loss was 0.45-1.4 kg per month. Therapy was typically initiated at 50 mg/day. The mean maximum dose was 93.9 mg/day and the median maximum dose was 100 mg/day. Seven (17.1%) patients had documented adverse effects to topiramate therapy.
Topiramate therapy resulted in overall modest (ie, <2%) decreases in weight and BMI, but many patients experienced more impressive weight loss. Therapy was generally well tolerated.
体重增加是许多精神药物（包括抗精神病药、抗抑郁药和心境稳定剂）常见的不良反应。越来越多的证据表明，托吡酯作为一种辅助治疗手段，对于经历了精神药物所致体重增加的患者，可能有助于诱导体重减轻。
确定在自然环境的心理健康诊所中，托吡酯治疗体重增加的疗效和耐受性。
在一家社区心理健康诊所进行回顾性病历审查。研究对象为非老年成年人，他们于2002年至2005年开始接受托吡酯治疗，以治疗因使用精神药物导致的体重增加。主要结局指标包括缓解率（基于任何程度的体重减轻）以及体重和体重指数（BMI）的平均变化。
41名患者纳入研究。缓解率为58.5%（n = 24）。体重和BMI的平均降低分别约为2.2千克和0.5个单位。有反应者平均减重7.2千克，而无反应者平均增重5.0千克。基线体重至少为91千克的患者以及服用更多精神药物的患者，接受托吡酯治疗更有可能取得成功。在24名对治疗有反应的患者中，22名在开始治疗或滴定至最终治疗剂量后的下一次诊所就诊（1 - 4个月）时出现体重减轻，通常的体重减轻速率为每月0.45 - 1.4千克。治疗通常从50毫克/天开始。平均最大剂量为93.9毫克/天，中位最大剂量为100毫克/天。7名（17.1%）患者记录了托吡酯治疗的不良反应。
托吡酯治疗使体重和BMI总体适度降低（即<2%），但许多患者体重减轻更为明显。该治疗一般耐受性良好。
