2Mg abilify weight gain

Abilify and Weight Gain: Causes & Contributing Factors

Abilify (Aripiprazole) is an atypical antipsychotic drug that is commonly used to treat severe psychiatric conditions like schizophrenia and bipolar disorder. In recent years, it has been heavily marketed as an antidepressant augmentation strategy. Despite the fact that this has been one of the most profitable medications of recent years, some research has suggested that its efficacy appears to be average.

In fact, most people end up eventually discontinuing treatment as a result of either the drug failing to treat their symptoms or tolerability issues. Like all antipsychotics, Abilify is capable of causing severe health problems such as neuroleptic malignant syndrome, high blood sugar, and increased risk of death. Additionally, even among individuals for which the drug is working well to manage symptoms, side effects like weight gain may be highly discouraging.

There is a lot of conflicting information regarding whether Abilify actually causes weight gain. Some doctors will explain that the drug is “weight neutral” and unlikely to affect your body-weight, while others may suggest that you’ll gain a marginal amount of weight throughout treatment. While compared to other atypical antipsychotics, Abilify tends to result in less “weight gain,” it doesn’t mean that the drug should be considered weight neutral for everyone.

The truth is that most people end up gaining some weight throughout their treatment with this drug. It is believed that its antagonist effect upon the 5-HT2C receptor is what may cause the gain.

How Abilify Causes Weight Gain

There are many ways in which this drug is capable of causing you to gain weight. Understand that what causes you to gain weight from this drug may be different for someone else. One person may experience an increase in appetite and start eating more, while another may believe their metabolism slowed. In other cases, a combination of these factors could lead to weight gain.

Appetite increase: Some people that take Abilify notice that it makes them have a bigger appetite than they did prior to taking it. If you constantly feel hungry and find yourself eating whatever food is in sight, it’s probably related to the medication. For some individuals the increase in appetite is modest, while among others it’s significant.
Blood sugar spikes: This is a drug that has been noted to affect levels of blood-glucose or blood sugars. When blood sugar levels are not stabilized, their instability may foster weight gain in some people. It is best to keep blood sugars in check throughout treatment and know that Abilify may be contributing to glucose spikes.
Cravings for food: If you find yourself craving food throughout the day, it could be from this medication. Many people taking antipsychotics have noticed that they start to crave unhealthy foods such as refined carbohydrates and sugars (e.g. candy) during treatment. Craving food as a result of Abilify is a factor that may lead to weight gain.

Fat storage: It is believed that antipsychotics have potential to modify the body’s fat storage mechanisms. This leads to more fat being stored in unwanted areas of the body and thus more overall weight gain. If your fat mass has significantly increased throughout treatment and your weight has gone up, it’s likely a result of Abilify.
Going out to eat: Assuming this drug helps with your psychiatric condition, you may start to feel more comfortable in public and/or may even start hanging out with friends again. Being social and more comfortable with yourself could lead you to go out to eat more frequently. Dining out tends to involve eating unhealthy foods with large portions. Additionally, if you start going to get “fast food,” it should be relatively obvious why you’re gaining weight.
Hormone levels: Abilify is capable of altering levels of naturally occurring hormones throughout the body. Disrupting homeostatic hormone levels with an antipsychotic drug may account for weight gain in some cases. Any drug that significantly affects the hormones naturally produced by your body could result in substantial weight gain.
Motivation deficit: Although the drug may affect everyone differently in terms of motivation, some people notice that their level of motivation significantly wanes throughout treatment. If you become less motivated to stay in shape or eat healthy, this makes it relatively easy to gain weight. Some people end up becoming lazy largely due to the fact that the drug has an uncontrollable influence over their physiology.
Side effects: You may experience unwanted side effects from the drug such as fatigue, drowsiness, and sleepiness that make it difficult to get adequate physical exercise. These side effects may be so severe, that it becomes a challenge to get out of bed in the morning. If you are debilitated by fatigue, this may further slow your metabolism because you aren’t getting much physical activity to keep it high.
Slow metabolism: If you are eating the same foods / portion sizes and getting the same amount of exercise during treatment as you were before taking Abilify, but are still gaining weight, it’s likely due to metabolic slowing. Drugs like Abilify have a tendency to slow your metabolism, resulting in weight gain even when your dietary and exercise habits haven’t changed. This can be frustrating, but is generally accepted as part of treatment.
Taste improvement: People who were really depressed before taking Abilify may notice that food tastes way better during treatment. Food may start to taste so good, that you may feel as though you can’t get enough. The taste improvement is likely to lead to you consuming bigger portions, more calories, and inevitable weight gain.

Note: The severity to which these factors are experienced is subject to individual variation.

Factors that influence weight gain on Abilify

There are many other factors that may influence the amount of weight you gain on Abilify. It is important to consider the dosage you’re taking, personal lifestyle factors, the duration for which you’ve been medicated, as well as if you are taking other medications.

1. Dosage

Most people taking Abilify for schizophrenia or bipolar disorder end up taking between 10 mg and 15 mg daily, but dosage can be increased all the way up to 30 mg. In general, you are more likely to experience weight gain as you increase the dosage. This is due to the fact that at higher doses, the drug has more influence over your natural physiology.

Certain physiological functions such as the body’s ability to store fat, along with important hormone levels that help prevent weight gain, become drastically altered. At lower doses, a person is less likely to gain weight simply because the drug has less influence over your physiology. For this reason, it is always recommended to use a “minimal effective dose” strategy if you are concerned about weight gain.

2. Individual factors

In some cases, it is necessary to take personal responsibility for some of the weight that you gain throughout treatment. If you have been overworking, not getting enough sleep, are eating a poor diet, or aren’t getting much exercise, those are all factors that can contribute to weight gain. It is often important to consider that there are certain behaviors that you are exhibiting that are directly contributing to weight gain.

There are also other individual factors such as: age, baseline metabolism, and genetics that could influence whether you gain weight while taking this drug. In order to get a better understanding of how your genetics may be reacting to the drug (to cause weight gain), you could look into a test called “GeneSight.” This type of test analyzes some genetic biomarkers and predicts whether you will react favorably vs. unfavorably to a particular psychiatric medication.

3. Time span

The duration over which you have taken the drug may have an impact on the amount of weight you gain. Some people notice significant weight gain in the short-term (i.e. 6 weeks), while others notice more significant weight gain over the long-term (i.e. years). In any regard, it is thought that the longer duration over which you have been treated with this drug, the more likely you will have gained weight.

Short-term: The shorter the term over which you’ve been taking the drug, the less likely you will be to have gained weight. It should be noted that some people experience a major spike in weight during the early stages of treatment, with no further significant weight gain over the long-term. Others experience an initial spike in weight, followed by more gradual increases in weight over the long-term. There are cases of patients gaining 20 lbs. within just 60 days of treatment.

Long-term: Those that have been taking Abilify for a long period of time are more likely to have experienced some sort of weight gain compared to those who only took it for a short duration. Being treated over the long-term generally results in a greater severity of drug-induced physiological alterations. Therefore homeostatic functions and hormone levels will be further from the baseline. It should also be noted that as a person stays medicated over the long-term, they may develop a tolerance. This generally results in a dosage increase, which is known to promote further weight gain.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000187/

4. Other medications

There are studies suggesting that certain medications are capable of causing increased weight gain while on Abilify. If you are taking a serotonergic antidepressant (SSRI) along with Abilify, there is greater likelihood that you’ll gain more weight than someone taking only Abilify. If you are on multiple medications, it is important to review them with your doctor to determine which may be the primary culprit for your weight gain.

Also understand that if you are taking a stimulatory drug such as Adderall or a non-serotonergic antidepressant, you may remain weight neutral while taking Abilify. Those that remain weight neutral are generally on a medication to stimulate the central nervous system, which helps offset the metabolic slowing that stems from antipsychotic usage.

How much weight will you gain from Abilify?

There’s no predicting exactly how much weight you’re going to gain from taking Abilify. Since there is significant individual variation, you’ll need to first take the medication for awhile and then evaluate whether you’ve gained any weight. Some people have reported that they gained an average of 5 lbs. to 10 lbs. per year of treatment, while other people have gained 40 lbs. within the first 6-months of treatment.

In other cases, people end up not gaining any weight. Although the average weight gain for adults taking Abilify is unknown, the experienced doctors know that on average, patients are probably going to gain at least 10% of their pre-drug body-weight as a result of the medication. Assuming you are 200 lbs. starting treatment, you may end up gaining at least 20 lbs.

Will everyone gain weight while taking Abilify?

Despite the fact that an overwhelming majority of people who take Abilify will gain weight, it doesn’t meant that everyone will experience noticeable weight gain. Some individuals may remain weight neutral (and in rare cases lose weight). Those that remain weight neutral generally are able to maintain a healthy diet, physical exercise, and/or are taking a medication that helps offset the weight-gaining effects of Abilify.

It is also important to point out that for people in need of an antipsychotic, this is considered one of the most “weight neutral” options. Nearly all antipsychotics are likely to cause some sort of weight gain, but Abilify is suggested to cause less weight gain than most others. Some people may experience weight loss if they switched to Abilify from another antipsychotic (e.g. Zyprexa) that is known to cause greater weight gain.

“Weighing” the Pros and Cons of Abilify

Throughout your treatment, it is important for you to conduct a cost-benefit analysis of this drug. In other words, “weigh” the side effects (including weight gain) and determine their severity. Next take a look at how well the drug is working to treat or manage your condition. If Abilify is working great to treat your condition, but you experience some minor side effects, it’s probably a good idea to continue treatment.

On the other hand, if you have gained a bunch of weight and the drug just isn’t working very well, you should talk to your doctor. Generally if a drug isn’t working to treat your condition and/or side effects are interfering with your well-being, you may want to consider a medication switch or Abilify withdrawal. No medication is worth staying on if you aren’t getting benefit.

Did you gain weight while taking Abilify?

For those that took Abilify, be sure to share whether you experienced weight gain. Was it consistent with the idea that you’ll gain at least 10% body-weight throughout treatment? If you gained weight, be sure to mention how much weight you gained, whether you noticed you gained more weight when your dosage increased, and how long you’ve been taking Abilify. Also be sure to note any other possible factors that may have caused you to gain weight throughout your treatment.

Source: http://www.ncbi.nlm.nih.gov/pubmed/23469329

Abilify Side Effects | Compulsive Behavior & Withdrawal Symptoms

Common Abilify (aripiprazole) side effects include nausea, vomiting, headache, insomnia and weight gain. Serious Abilify side effects include tardive dyskinesia and neuroleptic malignant syndrome. Stopping Abilify may cause withdrawal. Abilify withdrawal symptoms include anxiety, panic attacks and sweating.

Common Abilify Side Effects

Common side effects of Abilify include nausea, vomiting, dizziness, anxiety, insomnia, constipation, movement disorders and restlessness. The most common side effect is headaches.

Abilify, also known as aripiprazole, is an atypical antipsychotic medication that doctors prescribe for major depressive disorder, bipolar I disorder and schizophrenia, and to manage irritability from autism spectrum disorder or Tourette’s syndrome in children.

Other common side effects of Abilify include:

Blurred vision
Drooling
Drops in blood pressure when standing up
Constipation
Choking or trouble swallowing

Sleepiness is a common Abilify side effect for children ages 6 to 18. Other side effects for children include headache, nausea, vomiting, insomnia, movement disorders, increased appetite and weight gain.

If the drug does not reduce psychiatric symptoms, consider asking your doctor to switch you to a different antipsychotic medication.

Serious Side Effects of Abilify

Abilify can cause serious side effects, many of which can be dangerous to long-term physical and mental health. These include seizures, involuntary muscle movements and neuroleptic malignant syndrome. The drug is also associated with harmful metabolic changes, including weight gain, increased cholesterol, low white blood cell counts, insulin resistance and nonalcoholic fatty liver disease.

Abilify can cause new and worsening suicidal thoughts and impulse control disorders. People experiencing impulse control while taking Abilify might engage in behaviors such as compulsive gambling, hypersexuality, compulsive shopping and spontaneous wandering. Recent reports suggest Abilify might also cause obsessive-compulsive thoughts and behaviors.

Black Box Warning for Elderly Dementia Patients

Abilify’s drug label includes a black box warning stating that elderly people with dementia who take the drug are at an increased risk of death. In clinical trials, elderly people with dementia taking atypical antipsychotics such as Abilify were 1.7 times more likely to die than those in the control group.

Clinical data does not spell out the reason for this increased mortality risk, but suggests the problem is caused by multiple factors. Elderly people who take antipsychotics such as Abilify are more likely to suffer strokes, which are often fatal within this population. They may also be more vulnerable to cardiovascular events such as heart attacks and serious infections such as pneumonia.

Doctors normally prescribe Abilify for elderly patients with dementia when there is a serious risk the person will harm themselves or others. In some cases, the risks are necessary to prevent greater harm. If you or a loved one with dementia have a prescription for Abilify, take it exactly as directed by your doctor.

Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome is a rare, life-threatening reaction to antipsychotic drugs such as Abilify. It is a potential side effect of almost all antipsychotic drugs.

Characteristics of NMS include fever, altered mental status, muscle rigidity and instability of the autonomic nervous system. This system controls unconscious functions such as breathing, heart rate, digestion, urination and sexual arousal.

Tardive Dyskinesia (Uncontrolled Body Movements)

Tardive dyskinesia, another serious side effect of Abilify, is characterized by involuntary muscle movements throughout the body, but mostly in the lower face.

TD is most common among people who take Abilify for months or years, but it can manifest as soon as six weeks after beginning the drug. TD can go away after you stop taking Abilify, but sometimes it becomes a permanent condition.

Abilify and Weight Gain

Studies also link Abilify to weight gain, particularly in children. A 2022 review in Australasian Psychiatry examined 11 studies and found that young people (mean age 18) gained an average of 2.7 kg (6 pounds) while on aripiprazole. Youths who took the drug for longer periods (more than 12 weeks) gained more weight than those who took it for shorter periods. Dosage sizes had no impact on weight gain.

Abilify sometimes causes weight gain in adults. This happens less often than it does in children, and the total weight gain is usually less significant. Studies suggest that aripiprazole is less likely to cause weight gain in adults than most other antipsychotics in use today.

Abilify Withdrawal

Because Abilify affects how your brain works, stopping the drug all at once may lead to withdrawal symptoms. This is more likely when you quit the drug after long-term use or if you are used to taking high doses of the medication.

Abilify withdrawal symptoms include:

Anxiety
Appetite changes
Concentration problems
Confusion
Depression
Diarrhea
Dizziness
Hallucinations
Headache
Joint pain
Panic attacks
Sweating
Vomiting

Experts recommend tapering off Abilify if you want to stop taking it. Always consult your doctor for correct dosages when weaning yourself off of the drug.

Impulse Control Issues from Abilify

In 2014, a study published in JAMA Internal Medicine found that dopamine receptor agonist drugs such as Abilify were associated with new and worsening impulse control disorders. This research led to a new warning on the drug’s label, mandated by the U.S. Food and Drug Administration. This warning cautions that the drug may cause serious impulse control problems such as problem gambling, compulsive shopping and binge eating.

A 2022 review of impulse control disorder reports uploaded to the FDA Adverse Event Reporting System since December 2020 confirms that this association is still ongoing. About 94% of the impulse control disorder reports examined during the study involved people taking aripiprazole.

Many people who feel their lives were irreparably altered from gambling or uncontrolled impulse spending after taking the drug filed Abilify lawsuits to seek compensation.

Impulse control problems related to Abilify often go away when you stop taking the drug or reduce your dose. If you struggle with impulse control, talk to your doctor about reducing the dose or switching medications. Don’t lower your dosage or stop taking your medication without informing your doctor.

Compulsive Gambling

Problem gambling is the most common impulse control-related side effect of Abilify. The medication may be more likely to cause gambling problems than other related drugs with similar impulse control effects. A 2021 study of Swedish health records found that people taking Abilify were significantly more likely to develop problem gambling behaviors than people taking other dopamine agonists.

Most of those who develop gambling issues while taking Abilify have no prior history of problem gambling. Contact your doctor immediately if you have the urge to gamble more frequently than usual.

Sexual Side Effects of Abilify

Hypersexuality is another manifestation of Abilify’s effects on impulse control. This includes having unprotected sex, compulsive masturbation, having sex with multiple partners, or having sex outside of a committed relationship. Some people engage in sexting or share explicit images of themselves.

FDA data shows that 34% of people affected by antipsychotic-related impulse control disorders display uncharacteristic hypersexual thoughts or behaviors. Like Abilify’s other impulse control side effects, hypersexual behavior usually stops when you stop taking the drug or lower your dose.

Suicidal Thoughts

People who take Abilify have an increased risk of developing suicidal thoughts and behaviors. For those who already experience these issues, Abilify may worsen them. The drugmaker now notes this side effect in the black box warning on the drug’s label.

Monitor yourself for new or worsening suicidal thoughts while taking Abilify. Contact your doctor immediately if you notice them. Don’t stop taking your medication without your doctor’s knowledge.

Aripiprazole Side Effects

Please seek the advice of a medical professional before making health care decisions.

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Cariprazine use and likelihood of weight gain

In clinical trials, weight gain in patients treated with cariprazine was comparable to weight gain with placebo ¹ .
Significant weight gain may occur in some patients while taking cariprazine and should be carefully monitored. ¹ .
Cariprazine is metabolically neutral: the incidence of hyperlipidemia, hyperglycemia and diabetes mellitus in clinical studies was comparable to the incidence of these events when using placebo ^2-4 .

In this section:

Antipsychotics may cause weight gain

People with schizophrenia are more likely to be overweight or obese than the general population ⁵ . During therapy with antipsychotic drugs, most patients may experience a clinically significant increase in body weight. Weight gain is a problem for patients because it can contribute to the development of type 2 diabetes, dyslipidemia and hypertension, which increases the risk of cardiovascular events ⁶ .
Although diet and a sedentary lifestyle also contribute to weight problems in patients with schizophrenia, strong evidence suggests that antipsychotics are a key factor in weight gain ^5.7 . This side effect is different for each antipsychotic drug. But no remedy works equally for all treated patients ⁸ . The incidence of clinically significant weight gain (≥7%) associated with treatment with atypical antipsychotics has been reported in the range of 8.1% (aripiprazole) ⁹ up to 22.2% (olanzapine) ¹⁰ .

Advice for clinicians and patients on managing weight gain

Because antipsychotics, including cariprazine, may be associated with weight gain, weight should be monitored in all patients with schizophrenia ¹ . Body mass index (BMI) is considered the accepted standard for deciding whether to correct overweight ⁵ .
The patient's waist circumference can also be an informative indicator of pathological weight gain. Women with a waist circumference ≥90 cm and men with a waist circumference ≥100 cm have an increased risk of high blood pressure, type 2 diabetes, dyslipidemia, and metabolic syndrome ¹¹ .

IMT ^12,13	Wessor
18.5-24.9	normal weight
25.0-29.9	Overweight
30 or more	Obesity

the patient to a doctor within the first 6 months after starting therapy or changing the drug ⁵ . If values are stable, weight and BMI should be checked quarterly in normal weight patients and more frequently in overweight patients.
Patients who visit more than 1 month apart should be educated about weight management and asked to come in off-schedule if they begin to gain weight ⁵ .
If the patient is gaining weight, counsel on dietary changes, exercise choices, use of weight loss medications, and consider switching from an antipsychotic to an agent that is less likely to cause weight gain ^14.15 .

Methods for preventing weight gain

As with other antipsychotics, weight gain has been observed in some patients with cariprazine ¹ . Studies have shown that when taking cariprazine, a weight gain of 1 kg occurred, both in short-term and long-term treatment ¹ . In a long-term study using dosages of 1.5 mg-6 mg/day, it was shown that weight gain was recorded in 9.0% of patients taking cariprazine ¹ . Compared with the placebo group, an increase in body weight was recorded in 5.1% of patients receiving cariprazine and 1. 5% of patients receiving placebo ¹⁶ .
In general, it can be said that cariprazine leads to a slight increase in body weight ¹ .

	Placebo n=683	Cariprazine 1.5-6 mg n=2048
Weight gain ¹	0.9 kg	1.1 kg
Age weight ≥7% ¹	7.1%	9.8%

Metabolic changes using carpentry Cariprazine does not appear to have a clinically significant adverse effect on metabolic parameters.
Mean (SD) changes in metabolic characteristics from baseline with authorized doses of cariprazine were small and clinically insignificant ⁴ .
The number of patients who experienced adverse events associated with hyperlipidemia was approximately 1% in all treatment groups. The number of patients who experienced adverse events associated with hyperglycemia and diabetes mellitus was <1% in the cariprazine treatment group and 1% in the placebo group ¹⁶ .

In short-term studies, changes from normal to high lipid and glucose levels were generally comparable between placebo and cariprazine ² .
In conclusion, the results of the study indicate that cariprazine may be considered an acceptable treatment option for patients with schizophrenia at risk of developing cardiovascular disease due to problems with excess weight or metabolic disorders ^2-4 .

Instructions for medical use of Reagila® RU: LP-005405 dated 03/18/2019. The instructions can be found on the website: www.grls.rosminzdrav.ru.

Sources:

Reagila SmPC. Instructions for medical use of Reagila® RU: LP-005405 dated 03/18/2019.
Earley, W. et al. Safety and tolerability of cariprazine in patients with acute exacerbation of schizophrenia: A pooled analysis of four phase II/III randomized, double-blind, placebo-controlled studies. Int. Clin. Psychopharmacol. 32, 319–28 (2017).
Leucht, S. et al. Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: Systematic review, Bayesian meta-analysis, and meta-regression of efficacy predictors. Am. J. Psychiatry 174, 927–942 (2017).
Citrome, L. Cariprazine in schizophrenia: Clinical efficacy, tolerability, and place in therapy. Adv. Ther. 30, 114–126 (2013).
Marder, S. R. et al. Physical health monitoring of patients with schizophrenia. Am. J. Psychiatry 161, 1334–1349 (2004).
Kapur, S. & Marques, T. R. Dopamine, striatum, antipsychotics, and questions about weight gain. JAMA Psychiatry 73, 107–108 (2016).
Padmavati, R., McCreadie, R. G. & Tirupati, S. Low prevalence of obesity and metabolic syndrome in never-treated chronic schizophrenia. Schizophr. Res. 121, 199–202 (2010).
Musil, R., Obermeier, M., Russ, P. & Hamerle, M. Weight gain and antipsychotics: A drug safety review. Expert Opin. drug safe. 14, 73–96 (2015).
Abilify [package insert]. Rockville, MD: Otsuka America Pharmaceutical, Inc https://www.otsuka-us.com/media/static/Abilify-PI.pdf (2018).
Zyprexa [package insert]. Indianapolis, IN: Lilly USA, LLC https://pi.lilly.com/us/zyprexa-pi.pdf (2018).
Janssen, I., Katzmarzyk, P. T. & Ross, R. Body Mass Index, Waist Circumference, and Health Risk. Arch. Intern. Med. 162, 2074–2079(2002).
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Heal. Organ. – Tech. Rep. Ser. (2000).
National Heart Lung and Blood Institute & National Institutes of Health (NIH) National Heart, Lung, and Blood Institute, N. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The Evidence Report, NIH Publication No. 98-4083. WMJ official publication of the State Medical Society of Wisconsin (1998) doi:10.1001/jama.2012.39.
Aquila, R. Management of weight gain in patients with schizophrenia. J.Clin. Psychiatry 63, 33–36 (2002).
Ball, M. P., Coons, V. B. & Buchanan, R. W. A program for treating olanzapine-related weight gain. Psychiatr. Serv. 52, 967–969 (2001).
EMA. Reagila Assessment Report. https://www.ema.europa.eu/en/documents/assessment-report/reagila-epar-public-assessment-report_en.pdf.

Advances in Therapy

Treatment with cariprazine: clinical efficacy, tolerability

Citrome L.

Adv Ther. 2013; 30(2):114–26.

"Potential candidates for treatment with cariprazine may include adult patients with schizophrenia for whom the risk of metabolic or cardiovascular disease is a concern, as well as patients in whom weight gain should be minimized or prevented."

Mechanism of action of Reagila Mechanism of action of Reagila

(Reagila® RU: LP-005405 dated 03/18/2019) The therapeutic effect of cariprazine is provided by a combination of partial agonism in relation to dopamine D3- and D2-recLearn more about the mechanism of action of Reagila

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Diabetes drugs may help reduce weight in people with HIV

A small preliminary study suggests that metformin, a drug used to treat type 2 diabetes, may have a role in reversing weight gain in people with HIV receiving antiretroviral treatment.

HIV-positive people with low CD4 counts, women, and black people tend to gain more weight after starting treatment. Although studies show that people gain an average of 2 kg in the first two years of treatment, a minority gain much more.

Significant weight gain while on HIV treatment increases the risk of developing cardiovascular disease and other conditions associated with obesity, such as cancer. Until now, the exact cause of weight gain has not been established. Determining treatment options that can limit or reverse weight gain may require a better understanding of what causes weight gain. Existing drugs that are indicated for weight management in people without HIV may equally well be used in weight management for people with HIV.

Metformin is one of the agents that has been proposed as a potential treatment option. The drug corrects blood sugar levels by increasing the amount of sugar absorbed by the tissues and decreasing the amount excreted by the liver.

In type 2 diabetes, the body does not respond to signals from the hormone insulin to move glucose from the blood to the tissues. Sugar builds up in the blood and can damage small blood vessels, eventually leading to kidney damage, nerve damage, and heart disease if left untreated.

Metformin also increases the number of bacteria (microbiota) in the gut, thereby reducing inflammation. These properties led Dr. Stefan Isnard of McGill University and his colleagues to question whether metformin could repair intestinal defects in people with HIV, reduce systemic inflammation, and also reduce weight.

The investigators recruited a cohort of 23 non-diabetic people with HIV with a viral load below 50 copies/mL who had been on antiretroviral treatment for at least three years and had a CD4/CD8 ratio <0. 7. The group was dominated by men, the average age was 56 years. Participants received antiretroviral treatment for a median of ten years, had a median CD4 count of 435, and a median CD4/CD8 ratio of 0.6. Eighteen of the 23 participants were on an integrase inhibitor regimen, the remainder were on regimens containing a boosted protease inhibitor or efavirenz.

Participants received 850 mg metformin orally twice a day for 12 weeks. And were observed within 12 weeks after cessation of treatment.

All study participants had fasting glucose levels within the normal range and did not change significantly during the study.

Although waist circumference did not change during the study, mean weight decreased by 1.6 kg over 12 weeks of treatment (-8 kg to +2.3 kg; p = 0.021) but returned to baseline 12 weeks after discontinuation taking metformin. The authors did not report a median starting weight, but participants' starting weights ranged from 50 to 120 kg.

Greater weight loss has been associated with higher levels of GDF-15, a protein that plays a role in regulating inflammation and helping people feel full.

Learn more