Medications that cause weight gain
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Medications That Cause Weight Gain: A Comprehensive Overview
Psychotropic Medications and Weight Gain
Antipsychotics and Weight Gain
Antipsychotic medications, both conventional and newer atypical antipsychotics, are frequently associated with significant weight gain. Drugs such as olanzapine, risperidone, quetiapine, and clozapine are particularly noted for this side effect 159. This weight gain can lead to serious health issues, including obesity, diabetes, and cardiovascular diseases, and often results in patients discontinuing their medication due to the intolerable side effects 1610.
Antidepressants and Weight Gain
Antidepressants, especially tricyclic antidepressants (TCAs) like amitriptyline and mirtazapine, are also linked to weight gain. Selective serotonin reuptake inhibitors (SSRIs) such as paroxetine can cause weight gain, although some, like fluoxetine and bupropion, may lead to weight loss in the short term 345. The weight gain associated with these medications is often due to their ability to block histaminergic, adrenergic, and cholinergic receptors, which play roles in appetite regulation .
Mood Stabilizers and Weight Gain
Mood stabilizers, including lithium and valproic acid, are known to cause weight gain. This side effect is particularly pronounced with lithium, which can also lead to metabolic disturbances such as impaired glucose tolerance and diabetes mellitus 169. The weight gain from these medications can be substantial and persistent, even after discontinuation of the drug .
Other Medications Associated with Weight Gain
Antihyperglycemics
Certain antihyperglycemic medications, such as insulin, sulfonylureas (e.g., glimepiride, glyburide), and thiazolidinediones (e.g., pioglitazone), are associated with weight gain. This is a significant concern as it can exacerbate the very conditions these drugs are meant to treat, such as diabetes and metabolic syndrome 58.
Antiepileptics
Antiepileptic drugs like valproate, carbamazepine, and gabapentin are also linked to weight gain. However, some antiepileptics, such as topiramate and zonisamide, may induce weight loss, offering alternatives for patients concerned about weight gain 59.
Mechanisms of Drug-Induced Weight Gain
Receptor Affinity and Appetite Regulation
The tendency of certain medications to cause weight gain is often related to their affinity for specific receptors involved in appetite regulation. For instance, the anti-histaminergic activity of some antidepressants is a strong predictor of weight gain. This is because blocking the H1-histamine receptor can increase appetite and lead to weight gain .
Metabolic Effects
Medications can also affect metabolic processes, leading to weight gain. For example, lithium has insulin-like effects that can alter glucose metabolism, while antipsychotics can impair glucose tolerance and increase the risk of diabetes 69.
Management and Prevention of Medication-Induced Weight Gain
Drug Selection and Monitoring
To manage and prevent weight gain, it is crucial to select medications with a lower risk of weight gain when possible. For patients at high risk of obesity or related health issues, alternative therapies that are weight-neutral or promote weight loss should be considered 278. Regular monitoring of weight, body mass index (BMI), and metabolic parameters is essential to detect and address weight gain early 610.
Lifestyle Interventions
Dietary counseling, increased physical activity, and behavioral treatments are effective strategies to mitigate weight gain. These interventions should be part of the routine management plan for patients on medications known to cause weight gain 168.
Conclusion
Weight gain is a common and significant side effect of many medications, particularly psychotropic drugs, antihyperglycemics, and antiepileptics. Understanding the mechanisms behind drug-induced weight gain and implementing strategies to manage and prevent it are crucial for improving patient outcomes and adherence to treatment. By carefully selecting medications and incorporating lifestyle interventions, healthcare providers can help mitigate the adverse effects of weight gain associated with these drugs.
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