Changes in weight and body mass index during treatment with melperone, clozapine and typical neuroleptics

Melperone is an atypical antipsychotic drug that has been reported to be effective in treatment-resistant schizophrenia and L-DOPA psychosis. There are limited data concerning its effect on weight or body mass index (BMI). Weight and BMI were retrospectively compared in patients with schizophrenia treated with melperone (n=34), clozapine (n=225), or typical neuroleptics (n=74) for up to 3 months. Clozapine resulted in significant increases in weight and BMI from baseline to 6 weeks and 3 months. Neither melperone nor typical neuroleptics resulted in significant weight gain at either time point. Melperone did not result in significant increases in BMI. Weight and BMI were significantly lower with melperone compared with clozapine, but similar to typical neuroleptics. The proportion of melperone patients who experienced a ≥7% weight increase was lower than that in patients treated with clozapine and similar to that in patients treated with typical neuroleptics. Percent change in weight and BMI predicted improvement in BPRS total scores at 3 months in the clozapine group, but not in the melperone or typical neuroleptic groups. Because of the relationship between BMI and cardiovascular risk, melperone deserves further study as both a first line treatment and as an alternative to clozapine in refractory schizophrenia.