Dramatic weight loss with rufinamide

Rufinamide (RUF) is a novel antiepileptic drug considered as second‐line therapy in the treatment of Lennox‐Gastaut syndrome. Treatment‐emergent adverse events (AEs) have consisted mainly of drowsiness, irritability, vomiting, and loss of appetite. RUF is considered as a “weight‐neutral” drug. We found clinically significant weight loss in 7 of 15 consecutive adult patients (47%; 3 male, 4 female, aged 18–31 years) treated with RUF as add‐on therapy (800–2,400 mg/day: 23.5–57.1 mg/kg/day). The body mass index (BMI) decreased by 7.3–18.7%. Two patients were obese class I before RUF. Five patients (71%) were underweight before RUF (mild in one case, moderate in two cases, and severe in two cases). Four of these patients stopped RUF because of this adverse effect. RUF was recommenced in two patients using a lower and slower dosing strategy; one patient showed improvement in seizure control and no weight loss but RUF was re‐stopped in the second patient because of continued weight loss. Despite of weight loss, RUF was continued in two other patients because it reduced seizure activity. We primarily related weight loss to reduced food intake, that is, loss of appetite and nausea, although in two patients no obvious loss of appetite was reported. RUF can cause clinically significant weight loss in adult patients, even at low dose. This AE can affect patients who are already underweight. There is a possibility that lower starting doses and slower escalation might minimize weight loss, but further information is required to determine whether this is the case.     

Dramatic weight loss with levetiracetam

BACKGROUND: Levetiracetam is considered a "weight-neutral" drug. We report 19 cases of significant weight loss associated with levetiracetam at a dose ranging from 500 to 2000 mg/day. METHODS: The population was divided into two groups. Group 1 includes patients in whom levetiracetam was the only possible cause of weight loss and Group 2 those in whom other factors may have played a role. Similar cases reported by the French national drug safety center were added (Group 3). RESULTS: Group 1 included 9 females and 3 males (weight loss ranging from 8.1% to 28.6%). Three patients had levetiracetam in monotherapy. Prior levetiracetam only three were overweight. One patient was hospitalized for a thorough assessment of weight loss. Seven patients reported reduced caloric intake due to decreased pleasure with food. The other five did not report any changes in feeding behavior. Group 2 included seven females with a weight loss ranging from 10% to 26.6%. One patient was on topiramate since two years prior to levetiracetam. Weight loss started with the introduction of levetiracetam. In 4 patients, there was a decreased dosage or cessation of a previous drug known to produce weight gain in some cases simultaneously to the introduction of levetiracetam, but in two of these patients these drugs had not produced any weight gain. Group 3 included only two patients (weight loss: 7 and 20 kg). CONCLUSIONS: This study provides evidence that levetiracetam can cause significant weight loss. Women are at higher risk while initial weight is not a factor.     

Body weight changes associated with psychopharmacology

OBJECTIVE: The authors discuss changes in body weight associated with various psychopharmaceuticals. METHODS: A large number of articles and books about drug-induced changes in body weight, selected on the basis of various literature searches and the authors' clinical experiences with psychopharmaceuticals, were reviewed. RESULTS: Many psychotropic drugs with antipsychotic, mood stabilizing, and antidepressant properties are associated with weight gain. Others, such as fluoxetine, isocarboxazid, nefazadone, topiramate, and psychostimulants, may cause weight loss. The antipsychotic drugs chlorpromazine, clozapine, and olanzapine are often associated with weight gain. Among antidepressants, amitriptyline and mirtazapine are known to cause weight gain. However, reductions are sometimes observed, and each antidepressant has its own unique weight-effect profile. Mood stabilizers, especially valproate-related products, are also associated with weight gain. CONCLUSIONS: Careful monitoring and consideration of alternative therapies are essential.     

Adolescent weight loss during treatment with olanzapine

Antipsychotic medications are increasingly used in adolescents for a variety of psychiatric difficulties, including psychosis, bipolar disorder, and aggression. Weight gain is a significant side effect of neuroleptics, which may limit adolescents' compliance with these medications. This report presents a case of significant weight loss while on olanzapine, with a body mass index (BMI) falling from 25 to 19.5 during 8 months of treatment. Possible mechanisms for this effect are discussed.     

Patient attitudes toward weight gain with medications

OBJECTIVE: The purpose of this study was to examine patient attitudes toward weight gain with medications under 4 conditions-medical vs psychiatric and life-threatening vs non-life-threatening. METHOD: In a suburban primary care practice, 241 patients completed surveys that explored the 4 study conditions and the amount of weight, from 0 to 20 or more pounds, willing to be gained on medication. RESULTS: Participants were willing to gain an average of 5.51 lb for a non-life-threatening medical condition, 5.37 lb for a non-life-threatening psychiatric condition, 13.30 lb for a life-threatening medical condition, and 12.70 lb for a life-threatening psychiatric condition. Participants were willing to gain significantly more weight with a medical vs psychiatric condition and with a life-threatening vs non-life-threatening condition. There were no significant gender differences in responses. CONCLUSIONS: There appear to be distinct patterns of acceptability of weight gain with medications. This information may enhance prescribers' ability to strategize medication compliance among patients.     

Double-blind, placebo-controlled investigation of amantadine for weight loss in subjects who gained weight with olanzapine

OBJECTIVE: This study sought to determine if amantadine affects weight gain in psychiatric patients taking olanzapine. METHOD: Twenty-one adults who had gained at least 5 lb with olanzapine were randomly assigned to receive amantadine (N=12) or placebo (N=9) in addition to olanzapine. The length of time taking olanzapine ranged from 1 to 44 months. Body mass index, psychiatric status, and fasting blood levels were assessed at baseline and 12 weeks. RESULTS: Significantly fewer subjects taking amantadine gained weight, with a mean change in body mass index of -0.07 kg/m2 for the amantadine group and 1.24 kg/m2 for the placebo group. This effect remained significant when the authors controlled for baseline body mass index and length of olanzapine treatment. No changes in fasting glucose, insulin, leptin, prolactin, and lipid levels were seen. Positive and Negative Syndrome Scale scores remained stable. CONCLUSIONS: Amantadine induced weight stabilization in subjects taking olanzapine and was well tolerated.     

Body weight in patients with Parkinson's disease.

There is some evidence suggesting that Parkinson's disease (PD) patients exhibit lower body weight when compared to age-matched healthy subjects. Low body mass index (BMI) is correlated with low bone mineral density, both of which are major risk factors for hip fractures. Possible determinants of weight loss in PD patients include hyposmia, impaired hand-mouth coordination, difficulty chewing, dysphagia, intestinal hypomotility, depression, decreased reward processing of dopaminergic mesolimbic regions, nausea, and anorexia as the side effects of medication, and increased energy requirements due to muscular rigidity and involuntary movements. It is unclear whether PD patients in general, or only a subgroup of those affected, definitely show lower BMI in the advanced stages of the disease. We therefore recommend that the body weight of PD patients be monitored monthly as the disease progresses, and that a patient's nutrition should be supplemented with sufficient amounts of vitamin D and calcium to reduce the risk of hip fractures and strengthen bone density. Because meal times may coincide with unpredictable off periods associated with akinesia and impaired hand-mouth coordination, PD patients also need flexible food schedules that accommodate the associated symptoms of this disease.     

Management of weight gain in patients with schizophrenia

Of the roughly 55% of the United States population that is considered overweight, half meet the criteria for obesity. Obesity is associated with serious health risks, but many clinicians graduate from medical school without a clear understanding of the effects of the foods that they and their patients consume. Obesity is more prevalent in people with mental illnesses, which poses an even greater challenge to clinicians. Antipsychotic treatment can cause weight gain, and mentally ill patients generally lack an understanding of nutrition as well as the ability to afford healthier foods. Therefore, clinicians must educate themselves about appropriate measures for preventing weight gain before or immediately after initiating antipsychotic therapy. Strategies for weight gain management that have proven effective in clinical trials include regular check-ups, lifestyle and medication counseling, medication assessments, behavioral control programs, and pharmacologic intervention. These approaches are necessary for clinicians to consider if efforts at reintegration of mentally ill patients are to succeed.     

Birth weight of children with Down's syndrome.

The difference in birth weight between children with Down's syndrome and their siblings was estimated to be in the interval from .18 to .37 kg with 90 percent confidence, the Down's syndrome infants having the smaller mean birth weights. When we adjusted their birth weight, using a multiple linear regression analysis, to take into account several factors known to affect it, the difference in birth weight was only slightly less than the unadjusted difference. The data support the hypothesis that an extra chromosome No. 21 results in a smaller than expected birth weight.     

Neurologic disorders associated with weight lifting and bodybuilding

Weight lifting and other forms of strength training are becoming more common because of an increased awareness of the need to maintain individual physical fitness. Emergency room data indicate that injuries caused by weight training have become more universal over time, likely because of increased participation rates. Neurologic injuries can result from weight lifting and related practices. Although predominantly peripheral nervous system injuries have been described, central nervous system disease may also occur. This article illustrates the types of neurologic disorders associated with weight lifting.     

Heparin-associated thrombocytopenia treatment with low molecular weight heparin

Eight patients with heparin associated thrombocytopenia (HAT) were treated by a low molecular weight heparin derivative (LMW). Biological and clinical improvement occurred in all patients. This efficiency confirms the antithrombotic activity of LMW and allows its use in patients with HAT.     

Body weight and self-esteem in patients with schizophrenia evaluated with B-WISE

BACKGROUND: Metabolic abnormalities and weight gain are an important problem in patients with schizophrenia. An instrument to evaluate body image and self-esteem related to weight has recently been developed (B-WISE). The first objective was to evaluate whether the findings of the original validation study could be confirmed in a European sample. The second objective was to explore the association of B-WISE scores with the metabolic syndrome and glucose abnormalities. METHODS: A Dutch translation of B-WISE was tested in a large sample of patients with schizophrenia (n=300) who underwent an extensive metabolic screening. RESULTS: The original findings with B-WISE were confirmed in an independent sample. Scores on B-WISE differed significantly as a function of BMI. Scores on B-WISE also differentiated patients with and without the metabolic syndrome and glucose abnormalities. Patients experiencing a recent weight gain had lower self-esteem and poorer psychosocial adaptation. CONCLUSION: B-WISE could be a useful instrument to evaluate the subjective psychosocial consequences associated with current weight and weight gain in patients with schizophrenia.     

Vocal development of infants with very low birth weight

This study describes the vocal development of infants born with very low birth weights (VLBW). Samples of vocalizations were recorded from three groups of infants when they were 8, 12 and 18 months of age: preterm VLBW infants with bronchopulmonary dysplasia (BPD), preterm VLBW infants without BPD, and healthy full-term infants. Infants with BPD produced significantly smaller canonical syllable ratios than the full-term infants throughout the period of study. Premature VLBW infants who did not suffer from BPD produced relatively little canonical babble at 8 months of age, but were performing within the range of the full-term infants at 18 months of age. At 18 months of age, the infants with BPD were reported to have significantly smaller expressive vocabulary sizes than the healthier preterm and full-term infants.     

A low molecular weight heparin compared with unfractionated heparin

A 6000 daltons low molecular weight heparin (LMWH) was compared with unfractionated mucosal heparin in vitro and in vivo. Despite unimpressive specifications by clotting assays in vitro, the LMWH gave high and sustained activity in vivo by anti-Factor Xa assays, following subcutaneous injection. However, activity measured by APTT and calcium thrombin time assays was at least as high as occurred following unfractionated heparin. On the basis of clotting assays, there seems no reason to expect a lower incidence of haemorrhagic side-effects following the clinical use of this LMWH. The study also strikingly demonstrates the inadequacy of in vitro clotting assays for assessing the in vivo behaviour of LMWH.