Antipsychotic-induced weight gain is fastest in the first months, and weight lost later is harder to lose than weight never gained. Metformin is cheap, widely available and has the largest trial base for this problem. Starting it early in those at high risk, such as young people starting olanzapine or clozapine, is easier than chasing the weight afterwards.
- Weigh at baseline and monthly for the first three months.
- Consider metformin from the start with olanzapine or clozapine in high-risk patients.
- Check renal function before starting and titrate slowly to limit gastrointestinal upset.
- Record waist circumference, not just weight.
Why it matters
Prevention is easier than reversal, and the early months are when most weight goes on.
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