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Published Online, 29 March 2005, www.theannals.com, DOI 10.1345/aph.1D423a.
 The Annals of Pharmacotherapy: Vol. 39, No. 5, pp. 976-977. DOI 10.1345/aph.1D423a
© 2005 Harvey Whitney Books Company.
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Comment: current options in the management of olanzapine-associated weight gain

Mukaila A Raji, MD MSc (Pharm)

Assistant Professor and Director Memory Loss Clinics, Sealy Center on Aging Department of Internal Medicine The University of Texas Medical Branch 301 University Boulevard Galveston, Texas 77555-0460 fax 409/772-6931 muraji{at}utmb.edu

Published Online, March 29, 2005. www.theannals.com, DOI 10.1345/aph.1D423a

TO THE EDITOR: In their review article, Drs. Hester and Thrower1 provided an excellent summary of the mechanism and management of olanzapine-associated weight gain, an undesirable side effect in children and adults, but not necessarily in the elderly population. Paradoxically, the "side effect" of weight gain with olanzapine (or any other psychotropic medication) may be an important reason to prescribe this medication in elderly psychotic patients. In these patients, especially those who reside in nursing homes, psychotic symptoms arise most commonly within the context of advanced Alzheimer's disease and other dementias, illnesses that carry a high risk of anorexia and weight loss and often lead to subsequent debility and premature death.2-6 For pharmacists, physicians, and nurses working with elderly nursing home residents, reversal of unintentional weight loss is a major, albeit difficult-to-achieve, clinical goal in these patients. In these frail elders, psychotropic medications that have additional side effects of increasing appetite and reversing weight loss may be most appropriate for treating psychosis, agitations, depressions, and other psychiatric comorbidities of Alzheimer's disease and other dementias.5-7 In other words, geriatric patients, especially those living in institutions in general and those with dementia in particular, may derive benefits from olanzapine-associated weight gain and may not need further management.

References

  1. Hester EK, Thrower MR. Current options in the management of olanzapine-associated weight gain. Ann Pharmacother 2005;39: 302-10. DOI 10.1345/aph.1D423[Abstract/Free Full Text]
  2. Schneider LS, Dagerman KS. Psychosis of Alzheimer's disease: clinical characteristics and history. J Psychiatr Res 2004;38:105-11.[CrossRef][Medline]
  3. Wang PN, Yang CL, Lin KN, Chen WT, Chwang LC, Liu HC. Weight loss, nutritional status and physical activity in patients with Alzheimer's disease. A controlled study. J Neurol 2004;251:314-20.[Medline]
  4. Volpato S, Romagnoni F, Soattin L, Ble A, Leoci V, Bollini C, et al. Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents. J Am Geriatr Soc 2004;52:886-91.[CrossRef][Medline]
  5. Fabiny AR, Kiel DP. Assessing and treating weight loss in nursing home patients. Clin Geriatr Med 1997;13:737-51.[Medline]
  6. White HK, McConnell ES, Bales CW, Kuchibhatla M. A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects. J Am Med Dir Assoc 2004;5:89-97.[Medline]
  7. Raji MA, Brady SR. Mirtazapine for treatment of depression and comorbidities in Alzheimer disease. Ann Pharmacother 2001;35: 1024-7. DOI 10.1345/aph.10371[Abstract]



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[Abstract] [Full Text] [PDF]

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