Mental illness is on the rise in today’s ever-changing society. Mental illnesses can be some of the most disturbing and upsetting to family members and patients. Many family members can lose sight of the person that once was, as a person’s brain chemistry can absolutely destroy their personality. One of the most destructive and devastating diseases is schizophrenia. Schizophrenia is quite complex, and it can present with a vast array of symptoms. Patients can present with various delusions, and can often have other manifestations of those delusions. Patients can feel paranoid, scared, and this can all present as disorganized thoughts or speech. Patients with schizophrenia are classified to have both positive and negative symptoms. Negative symptoms occur due to deficits in a person’s mental capacity. These symptoms can present as lack of cognition, inability to pay attention, and lack of memory. These symptoms can be thought to be a deficit in brain function. Patients can also have positive symptoms with schizophrenia. Positive symptoms can be thought of as hyperactivity of the brain. This can manifest as delusions, paranoia, and hallucinations. Although these are thought to be the “typical” schizophrenia symptoms, both are classic for a schizophrenia diagnosis. Unlike other mental health diseases, schizophrenia treatment is unpredictable in terms of response rates. Only about 20% of patients report satisfaction with their schizophrenia regimen. Some of the most classic medications with benefit in patients with schizophrenia are the second-generation antipsychotics. Olanzapine, the generic for Zyprexa, is a second generation antipsychotic. It has been proven effective for patients, but the unfavorable weight gain associated with olanzapine has hindered patient adherence and satisfaction. This weight gain is the most significant of the second-generation antipsychotics, along with clozapine. New strategies have been developed to address this issue.(1)
A new medication was recently granted FDA approval for the management of weight when patients are being treated with olanzapine. In addition to the olanzapine to manage schizophrenia, there is another component added to the medication to help subside weight gain. Olanzapine/samidorphan was approved by the FDA in May 2021. It contains the second generation antipsychotic and an opioid receptor antagonist to curve the associated weight gain. Samidorphan works similarly to naltrexone in curving weight gain. It is contraindicated in patients with opioid use disorders or those undergoing opioid addiction withdrawal. Patients should also avoid treatment if there is active opioid use for chronic or acute pain management. In patients on short-acting opioids, there should be a 7 day period before use of olanzapine and samidorphan. In patients using long-acting opioids for pain management, there should be a minimum of 14 days before use.
When thinking about increasing patients’ gaps in care and adherence, addressing burdensome side effects is one of the main strategies. Of course, with adding a new medication comes new side effects. It is important to weigh the risks and benefits of starting a new medication with patients and families. Patients with severe schizophrenic symptoms must be appropriately treated, and addressing weight gain is a very important strategy to increase adherence.
Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014;39(9):638-645.