Additional advice for adults

To manage specific cardiometabolic adverse effects in adults, see:

• Diabetes, including advice on managing people at risk of diabetes
• Blood pressure reduction
• Lipid modification
• General principles of managing excess body weight.

Metformin can attenuate weight gain caused by antipsychotics (average weight loss 3 kg) and reduce other cardiometabolic adverse effects associated with antipsychotics. Consider using metformin in conjunction with ongoing lifestyle interventions if adjusting antipsychotic therapy is ineffective or not possible, lifestyle interventions are ineffective, and the patient:

• has a body mass index (BMI) more than 25 kg/m2 or waist circumference indicating an increased risk of cardiometabolic disease
• has an increase in weight of more than 5 kg or waist circumference of more than 5 cm after starting the antipsychotic.