Most antipsychotic weight gain and metabolic change happens early, and olanzapine and clozapine carry the highest burden. Record weight or BMI, waist circumference, blood pressure, fasting glucose or HbA1c, and a lipid profile before starting or as soon as possible afterwards. Repeat weight frequently in the first weeks and the full set at about 12 weeks, then at least yearly. Early weight gain of more than about 7% is the signal to act: lifestyle support, a switch to a lower-risk agent, or adding metformin where appropriate.
- Record weight, waist, blood pressure, glucose or HbA1c and lipids before starting an antipsychotic.
- Weigh the patient regularly in the first six weeks, when gain is fastest.
- Repeat the full metabolic panel at about 12 weeks, then at least yearly.
- Treat a rise of more than about 7% in body weight as a trigger to review the drug.
Why it matters
The metabolic damage is front-loaded, so a check left to the annual review is too late to prevent it.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for psychiatry, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free