Sercan KARABULUT, Ceylan ERGÜL, Meliha ÖZTÜRK, Alp ÜÇOK

Şizofreni hastalarında antipsikotiklere bağlı yan etkilerin giderilmesinde metformin ve topiramatın yeri

Şizofreni hastalarının yaşam süresinin hasta olmayan akranlarına göre kısa olduğu bilinmektedir. Bunun en büyük nedeni artmış kardiovasküler hastalık riskidir. Kardiyovasküler hastalıklar ise obezite, sigara, diyabet, dislipidemi ve hipertansiyon ile ilişkilidir. Şizofreni hastalarının kullandığı antipsikotik ilaçlar obeziteye ve dislipidemiye neden olmaktadır. CATIE çalışmasında olanzapin alan hastaların %30"unun, ketiyapin alanların %16"sının, risperidon alanların %14"ünün, perfenazin alanların %12"sinin ve ziprasidon alanların %7"sinin başlangıç kilolarının %7'sinden fazlasını aldıkları bildirilmiştir. Şizofreni hastalarında antipsikotik ilaç alımına bağlı olan kilo alımını önlemede önerilen yöntemler yaşam tarzında değişiklik, kullanılan ilacın değiştirilmesi ve kilo kaybına yardımcı ilaç eklenmesi olabilir. Antidiyabetik bir ilaç olan metforminin diyabet dışı kilolu kişilerde yapılan çalışmalarda umut verici bir tedavi seçeneği oluşturduğu gösterilmiştir. Metforminin antipsikotik ilaçlara bağlı kilo alımını, açlık glikoz düzeyini, insülin düzeyini ve insülin direncini azalttığı ve antipsikotik kullanımına bağlı olan amenoreyi tedavi ettiği bildirilmiştir. Bir antiepileptik olan topiramatın da kilo artışını önlemek için kullanıldığı bildirilmektedir. Bu gözden geçirme yazısında metformin ve topiramatın antipskotiklere bağlı kilo artışını önlemede rol oynayan etki düzenekleri ve kullanım biçiminden söz edilecektir

The role of metformin and topiramate in reducing the side effects due to antipsychotics in patients with schizophrenia

It is known that the patients with schizophrenia have a shorter life span than their healthy peers. İncreased risk for cardiovascular disease is the most important contributor. There is a relationship between cardiovascular diseases and obesity, smoking, diabetes, dyslipidemia and hypertension. Antipsychotics cause obesity and dyslipidemia. The rate of 7% increase from baseline weight was reported as 30% in those who were taking olanzapine, 16% in those taking quetiapine, 14% in risperidone group, 12% in perphenazine group and 7% in ziprasidone group in CATIE study. Changing lifestyle, switching antipsychotic to another one or additional use of a medicine which helps to lose weight might be recommended to prevent weight gain due to antipsychotics in patients with schizophrenia. It has been shown that an antidiabetic agent, metformine is an effective treatment option in nondiabetic obese individuals. Metformin was reported as effective in reducing weight gain due to antipsychotics, fasting glucose level, insulin level, insulin resistance and amenorrhea due to antipsychotics. Topiramate, an antiepileptic agent was reported to use reducing weight gain as well. In this review, we will address the mechanisms action to prevent weight gain due to antipsychotics and dosing of metformin and topiramate

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