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Stopping Antipsychotic(Clozapine) Induced Weight Gain ?


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I'm on clozapine 100mg which I take at night, Fluoxetine 40mg, Modafinil 100mg and Propranolol 20mg.

 

I've gained around 35 pounds in the last 6 months alone which now is increasing rapidly cuz now I dont have any control over my food intake specially at night. I dont know why after taking clozapine at night, I wake up in middle of the night(like 4 am) and eat whatever carbs I can find even when I had a fulfilling dinner.

 

I've no problem following a low carb diet from like early morning through 10 pm. But after 10 pm, I've no control over my food intake. I think clozapine destroys my self control/willpower at night. 

 

Is there a way I can stop eating at mid night ? Are there any drugs I can take to combat the weight gain ? I cant stop taking clozapine, cuz it has been the only drug which saved me from paranoia.

Edited by clinic
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Naltrexone for me.  It got rid of the addictive nature of food for me. I still get hungry but isn't out of control like it had been when I was on clozaril.  Even after stopping it though, the addictive feeling of food never went away.  Naltrexone helps a lot with the cravings.

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It happened when I was taking 600mg of seroquel. I would wake up each night and start binge eating stuff from the fridge. Tons of food mostly carbs. I gained 60 lbs and went lap band surgery.

I went off seroquel to Invega and lost 40 lbs quickly. You would have to switch to another med that doesn't cause a lot of weight gain. Will power doesn't work when the med actually causes it on purpose.

 

I have not heard of a person taking bad AAS who hasn't gained 30-60 pounds in a year. Now with Latuda, my BMI is 27. It used to be 36.5 with Risperidone and Seroquel.

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I agree with only having healthy foods in your fridge. Lots of fruits and veggies, lean meats, etc. Maybe stay away from the cheese. Cherry tomatoes are great. So are dates, super sweet. Let your carby foods only be things like rice, pasta, quinoa, beans etc. Things that you can't eat impulsively unlike frozen foods, bread, chips, tortillas, etc. I don't think you're going to get up and binge on uncooked rice lol. And I don't think you'll have the patience to cook your carbs and then binge eat. 

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  • 4 weeks later...

I asked pdoc about metformin and if I can take it or not. He said yes!

 

So he added metformin 500mg twice daily which I've been taking since 4 days. I'm taking the SR(slow release) version of metformin. Ive not noticed anything. I still eat like crazy at midnight. Clozapine is still winning through binge eating. Maybe it will take some time to work.

Edited by clinic
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I asked pdoc about metformin and if I can take it or not. He said yes!

 

So he added metformin 500mg twice daily which I've been taking since 4 days. I'm taking the SR(slow release) version of metformin. Ive not noticed anything. I still eat like crazy at midnight. Clozapine is still winning through binge eating. Maybe it will take some time to work.

 

 

I think you are right.  I'd give it some time, at least a month if not 6-8 weeks.

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Been taking metformin for some days without any side effects. But suddenly yesterday, I got this acute diarrhea and abdominal cramps. Been taking oral rehydration solutions and antidiarrheal drug to help with side effects. I'm going to temporary stop metformin. Will think about it later.

 

On positive side, I noticed mixed results on metformin. I would go 3-4 days without waking up middle of the night and then there were days when I did wake up middle of the night just to eat. I dont know what to say as of now.

 

 

 

The most common adverse effect of metformin is gastrointestinal irritation, including diarrhea, cramps, nausea, vomiting, and increased flatulence; metformin is more commonly associated with gastrointestinal side effects than most other antidiabetic drugs.

 

source: http://en.wikipedia.org/wiki/Metformin#Adverse_effects

Edited by clinic
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  • 4 weeks later...

Hey, its been a while.

 

So pdoc added zolpidem yesterday in the hopes i stay asleep instead of waking up middle of the night to just eat. Took first dose last night, too soon to say anything - but I noticed hallucinations like all types of stuff in my bedroom moving within 15 minutes of taking it. Like insects crawling on my computer table lol. I will try zolpidem for some days and see if it makes me stay asleep without waking up.

 

2nd option pdoc said is to try splitting clozapine 100mg into two 50mg doses. One at night and the other in the morning. And see if it helps with weight loss.

 

3rd option pdoc said is to reduce clozapine and add another antipsychotic which does not increase much weight like arpiprazole. So he said taking two different antipsychotics may help with weight loss. 

 

I found a comparative meta analysis of antipsychotics sorted by efficacy and weight gain - https://www.dropbox.com/s/4blbsbdngox1fko/Leucht-2013-15-antipsychotics-meta-analyses.pdf?dl=0

 

So the above data says the following are the antipsychotics with least(Arpiprazole) to the most weight gain potential(clozapine). Thats standard mean score in bracket.

 
1. Arpiprazole (0.17)
2. Amisulpride (0.20) (Qtc prolongation)
3. Paliperidone (0.38) (high prolactin)
4. Resperidone (0.42) (high prolactin)
5. Quetiapine (0.43)
6. Clozapine (0.65)

 

I'm curious about Amisulpride as its available in my country. Anybody have tried it here ? Did it cause weight gain for you ? It causes Qtc prolongation though.

Edited by clinic
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Amisulpride as its available in my country. Anybody have tried it here ?

I was on amisulpride back in 2003. Its called Solian here in Australia.

How did it work for you ? It didn't do squat. Been on it 3 times. Been up to 1200mg.

Edited by itchandscratch
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I dropped amisulpride like a shot when it caused lactation.

 

I was thinking if i should try amisulpride due to it being 2nd most effective drug after clozapine but I thought the prolactin increase would be too much for me. I don't want man boobs.

 

I've decreased clozapine as of now due to weight gain, and I'm thinking about adding another antipsychotic to compensate for it.

 

Now my options in order of preference are:

 

1. Quetiapine

2. Ziprasidone

3. Asenapine 

4. Lurasidone

5. Aripiprazole (I discontinued it 1 year back when it caused cognitive decline(poor memory/attention), but may try again if the above 4 fails)

 

Which one do you guys suggest ? Am I missing any other options which does not cause much weight gain, prolactin elevation and qTC prolongation ? The latter ones after quetiapine except Arpiprazole are not much effective.

Edited by clinic
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