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03. Antipsychotic-Induced Weight Gain: Prevention and Management

Published on March 1, 2025 Certification expiration date: March 1, 2028

Oliver Freudenreich, M.D.

Co-Director of the MGH Psychosis Clinical and Research Program, Massachusetts General Hospital - Professor of Clinical Psychiatry, Harvard Medical School

Key Points

  • Olanzapine and clozapine have the highest metabolic risk. Switching to aripiprazole or ziprasidone may help if clinically appropriate.
  • Consider metformin early (500 mg/day, increase weekly to 2000 mg/day) when weight gain occurs. Avoid in alcoholism and renal failure.
  • GLP-1 receptor agonists may become important treatment options for antipsychotic-induced weight gain.

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Learning Objectives:

After completing this activity, the learner will be able to:

  1. Identify antipsychotic receptor binding profiles and their associated side effects, including H1 receptor blockade causing sedation and weight gain, alpha-1 blockade causing orthostatic hypotension, and muscarinic blockade leading to anticholinergic effects, to make informed medication selections and provide anticipatory guidance to patients.
  2. Implement evidence-based management strategies for antipsychotic-induced metabolic side effects, including appropriate medication selection, early intervention with metformin when weight gain occurs.
  3. Recognize and appropriately manage severe antipsychotic-induced movement disorders, including akathisia, neuroleptic malignant syndrome, and tardive dyskinesia, through early detection, pharmacologic interventions, and antipsychotic selection or adjustment when indicated.

Original Release Date: March 1, 2025
Expiration Date: March 1, 2028

Expert: Oliver Freudenreich, M.D.
Medical Editor: Flavio Guzmán, M.D.

Relevant Financial Disclosures:
Oliver Freudenreich declares the following interests:

– Alkermes:  Research grant, consultant honoraria
– Janssen: Research grant, consultant honoraria
– Otsuka: Research grant
– Karuna: Research grant, consultant honoraria
– Neurocrine: Consultant honoraria
– Vida: Consultant honoraria
– American Psychiatric Association: Consultant honoraria
– Medscape: Honoraria
– Elsevier: Honoraria
– Wolters-Kluwer: Royalties
– UpToDate: Royalties, honoraria

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.
None of the other faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:
Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

  1. View the required educational content provided on this course page.
  2. Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
  3. Download your certificate.

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians

Credit Designation Statement
Medical Academy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Artificial Intelligence (AI) Use DisclosureArtificial intelligence (AI) tools may have been used in limited stages of developing this activity (e.g., drafting or language refinement). The specific tool, version, and date of use are documented internally.AI does not determine clinical recommendations. All content is reviewed, verified, and approved by the listed faculty and medical editors, and reflects independent human clinical judgment consistent with ACCME Standards for Integrity and Independence in Accredited Continuing Education.

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