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  • Amantadine fights Zyprexa-induced weight gain

    Posted by .(JavaScript must be enabled to view this email address)
    Saturday, March 20, 2004 2:26 pm Email this article
    Symmetrel (amantadine) caused an average weight loss of 7.7 pounds in twelve patients who had gained an average of 16.1 pounds while taking the antipsychotic drug Zyprexa (olanzapine) according to a study by Floris (2001).

    100-300 MG PER DAY

    The dose of amantadine was 100-300 mg per day.

    3-6 MONTHS

    The weight loss occurred over 3-6 months.


    The amantadine did not cause any clinical deterioration, and no adverse effects were reported.

    This study was not a randomized, placebo-controlled trial.


    Zyprexa (olanzapine) is a drug used to treat schizophrenia. It works by decreasing unusually high levels of brain activity.

    Symmetrel (amantadine) is an antiviral used to prevent or treat certain influenza type A according to The National Institutes of Health Medline Plus.


    Symmetrel (amantadine) was originally used in the treatment and prevention of influenza type A, but has also been found helpful in drug-induced Parkinsonism, Parkinson’s disease, traumatic head injury, dementia, multiple sclerosis and cocaine withdrawal according to a review by Huber et al (1999).


    Amantadine appears to act through several pharmacological mechanisms, none of which has been identified as the one chief mode of action.

    It is a dopaminergic, noradrenergic and serotonergic substance, blocks monoaminoxidase A (MAO A) and NMDA receptors, and seems to raise beta-endorphin levels according to Huber et al (1999).

    However, it is is not known which of these actions are relevant at the doses that people take.


    Some evidence suggests that Symmetrel (amantadine) may also have an antidepressant effect.


    Floris M, Lejeune J, Deberdt W. Effect of amantadine on weight gain during olanzapine treatment. Eur Neuropsychopharmacol. 2001 Apr, 11(2):181-82.

    Huber T, Dietrich D, Emrich H. Possible use of amantadine in depression. Pharmacopsychiatry. 1999 Mar, 32(2):47-55.

    Articles on the same subject can be found here:


    On Mar 22, 2004 at 11:08 am Monte Meldman, MD wrote:

    . . . . .

    Everyone "knows" that the alpha-1 adrenergic "diet pills" are contraindicated in Schizophrenia and according to marketing data might cause an exacerbation of Mania, or hallucinations and delusions etc.

    But no on has had the temerity to try Phentermine and a 1000 calorie diet and a cognitive behavioral therapy program on this type of weight gain. So we may never learn what would happen.

    My impression of diet pills is that they make people feel better and are, on balance, a lot better antidepressants than the SSRI's.

    Incidentally the name of Wellbutrin is Buprion and the name of Tenuate is Diethyl Propion. So the drugs are virtually the same. One --propion is the same as the other --propion!?

    In fact, Tenuate is in my experience a better antidepressant than all of the SSRI's and as good as Wellbutrin and a lot cheaper.

    I have seen hundreds of women made fat and frigid on SSRI'S like Paxil, Zoloft, Celexa, Luvox and now Lexapro.

    Tenuate is a far better antidepressant than any of these agents.

    The critical problem is to use small doses and build up gradually.

    I do not think that fast schizophrenia is any worse than slow schizophrenia, so a trial of Tenuate certainly is merited in the?Zyprexa and diabetes and Obesity dillema.

    This is going to get worse in the near future as?someone has recently shown that a combination of Zyprexa and Prozac works the best for the treatment of BiPolar I and II. Those folks are going to get real fat.

    On Mar 22, 2004 at 11:12 am Michael Anchors, MD, PhD wrote:

    . . . . .

    Last Thursday I did a little research at the National Library of Medicine andcould find no published evidence for exacerbation of mania by phentermine. It seems the concern is only theoretical. In a couple of cases where I gave phentermine to bipolar patients gaining weight on Zyprexa, I saw no effect on their bipolar disease.

    I did not search for an interaction between schizophrenia and phentermine since I can't picturegiving phen-pro to a schizophrenic since they could not cooperate with the diet. Anyway every sick schizophrenic I have ever met has been lean.

    I have not foundeither Tenuate or Bupropion (Wellbutrin) to beparticularly effective as an antidepressant. I have found that Bupropion is somewhat helpful with quiting smoking. I thought the proponents of Bupriopion claimed that it released dopamine, hence its usefulness in smoking cessation. Phentermine releases norepinephrine and has little effect on dopamine.

    On Mar 23, 2004 at 9:46 am Jay Piatek, MD wrote:

    . . . . .

    It is actually not unusual in my practice to see patients gaining on medications, especially the Seroquel and the Neurotin.

    I have actually had patients gain over 20 pounds in a short period of time on Neurotin. The good news is that there are acceptable solutions.

    I have had great success with Topamax and Zonegran more recently. Topamax seems to be a lot better for the pain syndromes.

    They are also used for bi-polar disease.

    They can be an add-on medication or used independently either with Seroquel and Neurotin or by themselves.

    I have much experience, treated over 1,500 people with the Topamax and over 700 with Zonegran.

    Zonegran seems to be much better for sweets and for binge eating where Topamax is much better for pop drinking and for pain states.

    Ive not been very impressed with results with exercise as far as weight loss.

    I do see when you give the medications like Adipex that does help then.

    It is so important to cut the appetite to see weight loss rather than push the exercise as much.

    Get rid of the pain first, lose weight, and then exercise will be much easier.

    Jay Piatek, MD
    The Piatek Institut
    745 Beachway Drive
    Indianapolis, IN? 46224-7700
    (317) 243-3000 phone
    (317) 246-7729 fax

    On Mar 23, 2004 at 2:43 pm Mark Eig, M.D. wrote:

    . . . . .

    I would like to add that as a result of phentermine.

    I have seen a case of mania in a previously asymptomatic patient with a remote family history of manic depressive psychosis (a term i prefer to the too nebulous bipolar disease of today).

    The patient has been treated by a psychiatrist and for a brief time after 6 months of stability on therapy, rechallenged with a low dose of phentermine without consequence.

    The phentermine therapy was not continued for other reasons (her husband insisted). also I have given phentermine to patients with a diagnosis of bipolar disease as long as they are stable in their therapy and do not have a recent history of 'uncontrolled' mania.

    Also these patients must be reliable in that they must follow dosing instructions and be patient with the slow incremental increases.

    They must also pay strict attention to appointments, no lost perscriptions, etc...

    I cut them off at first offenses.

    Mark Eig, M.D.

    On Mar 28, 2004 at 6:29 pm Alan N. Schulman, MD wrote:

    . . . . .

    Geodon is a newer atypical neuroleptic with, broadly speaking, the same indications and efficacy as Zyprexa MINUS the weight gain.

    Additionally, Topamax often provides additional excellent and much sought after "mood stabilization" PLUS often effective bariatrics at doses > or = 100 mg., usually given a.h.s. (start at 25 mg, add 25 mg weekly to 100 to 200).

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