Metformin

Metformin Overview for Patients on Atypical (2nd generation) Antipsychotics

What is Metformin?

Metformin is a commonly prescribed medication for managing type 2 diabetes. It is also effective in preventing weight gain in patients who are taking atypical antipsychotics, which are known to cause weight gain as a side effect.

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Is Metformin Safe for Children?

Yes, metformin has been studied in children and teenagers on atypical antipsychotics and has been shown to safely prevent weight gain. Additionally, those on metformin often experience emotional improvements, suggesting secondary benefits on mood.

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How is Metformin Dosed?

For most patients, the starting dose is 500mg twice daily, taken with breakfast and dinner to minimize gastrointestinal upset. The target dose for those aged 14 and older is typically 1000mg BID. For children under 14, the dosing starts at 500mg daily, with an evening dose added after 7 days.

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Supplement Recommendations with Metformin:

Because metformin can lead to Vitamin B12 deficiency in over 10% of users, it is recommended to take a Vitamin B12 supplement when taking metformin. A 500mcg dose is a good option; follow the instructions on the bottle.

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Common Side Effects:

Metformin is generally well-tolerated, but some people may experience gastrointestinal issues such as nausea, cramps, diarrhea, flatulence, and, rarely, vomiting. These side effects can often be minimized by starting at a lower dose and taking the medication with food. Most side effects tend to improve over time.

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Contraindications:

Individuals with kidney disease or a low glomerular filtration rate (GFR < 30) should not take metformin due to the increased risk of metabolic acidosis.

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Mechanism of Action:

• Decreases glucose production by the liver

  
  

• Increases insulin sensitivity by boosting insulin receptors

  
  

• Enhances secretion of growth differentiating factor, reducing appetite

  
  

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Metabolic Benefits:

• Improves insulin sensitivity

  
  

• Reduces weight and waist circumference

  
  

• Lowers triglycerides

  
  

• Decreases the risk of obesity

  
  

• Prevents weight gain associated with atypical antipsychotics

  
  

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Non-Metabolic Benefits:

• Lowers serum prolactin levels (elevated by antipsychotics like risperidone)

  
  

• Promotes neurogenesis in the brain

  
  

• Enhances cognition

  
  

• Mitigates blunting effects of some antipsychotics

  
  

• Reduces anxiety by increasing serotonin levels and activity

  
  

• Improves fertility in women with PCOS

  
  

• Exhibits anti-aging properties and may extend life longevity

  
  

• Provides anti-inflammatory benefits, potentially aiding conditions like IBD, osteoporosis, neurodegeneration, and frailty

  
  

• Research supports improvements in irritability for children and teenagers on metformin

  
  

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Written by:

Joseph Gagnon Jr.