Veerman S R T, Cohen D
Tijdschr Psychiatr. 2023;65(4):259-265.
Metformin is the most investigated pharmacological treatment of antipsychotics-induced weight gain (AIWG). Based on a systematic literature review, the first guideline for the treatment of AIWG with metformin was recently published.
To present a step-by-step plan, based on recent literature and clinical experience to monitor, prevent, and treat AIWG.
Literature search to give specific advice on the choice of antipsychotic medication, stop, dose reduction or switch of antipsychotic, screening, non-pharmacological and pharmacological interventions to prevent and treat AIWG.
Especially in the first year of antipsychotic treatment timely detection of AIWG through regular monitoring is pivotal. The best way to treat AIWG is to prevent its emergence by choosing an antipsychotic with a favourable metabolic profile. Secondly, by titration of antipsychotic medication to the lowest dose possible. Achieving a healthy lifestyle shows a limited beneficial effect on AIWG. Drug-induced weight loss can be attained by the addition of metformin, topiramate, or aripiprazole. Topiramate and aripiprazole can improve positive and negative residual symptoms of schizophrenia. The evidence on liraglutide is scarce. All augmentation strategies may cause side effects. Besides, in case of nonresponse augmentation therapy should be stopped to prevent unnecessary polypharmacy.
In the revision of the Dutch multidisciplinary guideline for schizophrenia, the detection, prevention, and treatment of AIWG deserves more attention.
二甲双胍是针对抗精神病药物所致体重增加（AIWG）研究最多的药物治疗方法。基于一项系统的文献综述，最近发布了关于使用二甲双胍治疗AIWG的首个指南。
根据近期文献和临床经验，提出一个用于监测、预防和治疗AIWG的分步计划。
进行文献检索，以就抗精神病药物的选择、停用、剂量减少或换药、筛查以及预防和治疗AIWG的非药物和药物干预提供具体建议。
尤其是在抗精神病药物治疗的第一年，通过定期监测及时发现AIWG至关重要。治疗AIWG的最佳方法是通过选择具有良好代谢特征的抗精神病药物来预防其出现。其次，将抗精神病药物滴定至尽可能低的剂量。保持健康的生活方式对AIWG的有益作用有限。添加二甲双胍、托吡酯或阿立哌唑可实现药物性体重减轻。托吡酯和阿立哌唑可改善精神分裂症的阳性和阴性残留症状。关于利拉鲁肽的证据较少。所有增效策略都可能引起副作用。此外，如果无反应，应停止增效治疗以避免不必要的多药联用。
在荷兰精神分裂症多学科指南的修订中，AIWG的检测、预防和治疗值得更多关注。
