Metformin for the Prevention of the Metabolic Side-effects of Zyprexa

Study Overview
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Brief Summary
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We hypothesize that metformin co-administered with olanzapine will be well tolerated and associated with significantly less insulin resistance, weight gain and dyslipidemia as compared to olanzapine plus placebo.

Detailed Description
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Increased risk of metabolic complications with olanzapine therapy, relative to other antipsychotics, may lead clinicians to avoid its use, despite evidence of greater efficacy. These problems may also pose a therapeutic dilemma for patients who respond well to olanzapine. Metabolic complications negatively impact on morbidity and mortality, impair quality of life and increase illness relapse secondary to medication non-compliance. Thus far, no pharmacologic agent co-administered with olanzapine has proven effective at preventing these untoward effects. The present study proposes to examine the efficacy and safety of metformin to attenuate the metabolic side effects associated with olanzapine.

Official Title
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Metformin to Prevent the Metabolic Complications of Olanzapine

Conditions
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Metabolic Complications

Intervention / Treatment
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* Drug: Metformin
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of: Schizophrenia, Schizoaffective Disorder, Bipolar I or II or major depression with psychotic features who will be started on or who have just started taking Olanzapine (Zyprexa). Exclusion Criteria: Patients with either a history of diabetes mellitus or a baseline FBG>126 or two random blood sugars of > 200 or during a OGTT glucose level of > 200 two hours after a glucose load of 50 grams. (All American Diabetes Association criteria for diabetes mellitus). Baseline liver function tests (SGOT, SGPT, AP) greater than 3X normal. Chronic alcoholism MDRD less than 60 ml/1.73 m2. Modification of Diet in Renal Disease (MDRD) Equation estimates the glomerular filtration rate as a measure of kidney function. This equation takes into account the plasma creatinine, age, race and gender, and is a more accurate estimation of glomerular filtration rate than serum creatinine alone. Patients with unstable medical problems, including cardiovascular instability or significant congestive heart failure (as determined by study investigators). Prolonged QTc greater than 430 ms on baseline EKG. History of lactic acidosis. History of hypoglycemia. Current treatment with metformin or other antidiabetic agents. Treatment with any antihyperlipidemic medication within 3 months of randomization. Treatment with olanzapine or clozapine within 3 months of randomization. Concurrent treatment with ziprasidone, risperidone, quetiapine or aripiprazole or any other neuroleptic medication. Concurrent use of OTC chromium, gymnema or cimetidine will be prohibited. Patient may discontinue these medications up to one day prior to randomization. Current treatment with corticosteroids.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 1<br>Olanzapine plus metformin: olanzapine plus metformin 500 mg titrated up to but no greater than 2,000 mg based upon fasting blood glucose during study visits over six months. | Drug: Metformin<br>* Drug: Metformin 500 mg po daily titrated up to but no greater than 2000 mg based upon fasting blood glucose during study visits over six months.<br>* Other names: Diaformin;|
| Placebo Comparator: 2<br>Olanzapine plus Drug: Placebo. Subjects will remain on olanzapine plus placebo for 6 months. | Drug: Placebo<br>* Drug: Placebo. Subjects will remain on placebo for 6 months.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Weight Gain | Change from Baseline in weight | Baseline and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hemoglobin A1C | change from baseline in hemoglobin AIC | Baseline and 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Olanzapine, Zyprexa, Weight Gain, Antipsychotics, Metformin, Glucophage, Bipolar Disorder, Schizophrenia, Depression, Diabetes, Side effects, Metabolic complications, Prevention, Treatment, Metabolic side effects of olanzapine