Propranolol side effects weight gain
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Propranolol Side Effects: Weight Gain
Introduction to Propranolol and Its Uses
Propranolol is a non-selective beta-blocker commonly prescribed for various conditions, including hypertension, anxiety, and migraine prevention. While effective in managing these conditions, propranolol has been associated with several side effects, one of which is weight gain.
Evidence of Weight Gain from Long-Term Propranolol Use
Clinical Trials and Retrospective Analyses
A significant body of research indicates that long-term use of propranolol can lead to weight gain. A retrospective analysis of the Beta Blocker Heart Attack Trial, which included 3,837 men and women, found that patients treated with propranolol experienced a mean weight gain of 2.3 kg after one year, compared to 1.2 kg in the placebo group. This weight gain persisted over subsequent years, suggesting a sustained effect1.
Case Reports and Short-Term Use
Even short-term use of propranolol has been linked to weight gain. A case report highlighted a 34-year-old woman who experienced a rapid weight gain of 3 kg within two weeks of starting low-dose propranolol for anxiety-related tremors. This weight gain was attributed to increased appetite and overeating, which ceased upon discontinuation of the drug4.
Mechanisms Behind Propranolol-Induced Weight Gain
Metabolic Changes and Appetite
Propranolol may influence weight gain through several mechanisms. Research involving animal models has shown that propranolol-treated rats gained significant weight over six weeks, despite starting with a lower initial weight compared to controls. This weight gain was associated with higher insulin levels, increased blood glucose, and reduced muscle glycogen, indicating potential insulin resistance and altered metabolism3.
Hormonal and Enzymatic Effects
Propranolol's impact on weight may also involve hormonal changes. The drug has been shown to reduce the activity of lipolytic enzymes, which are crucial for breaking down fats, thereby promoting fat accumulation3. Additionally, propranolol may affect satiety hormones, leading to increased appetite and subsequent weight gain3.
Comparative Analysis with Other Medications
Migraine Prevention and Weight Gain
In the context of migraine prevention, propranolol is one of several medications associated with weight gain. A review of clinical studies found that while propranolol does cause weight gain, the incidence is lower compared to other migraine-preventive drugs like amitriptyline and divalproex sodium. This suggests that while propranolol is not the most significant contributor to weight gain among these medications, it still poses a risk6.
Alternatives to Propranolol
Given the potential for weight gain, alternative medications may be considered. For instance, cardio-selective beta-blockers like atenolol have been suggested as better options for patients who need to manage their weight while controlling blood pressure3.
Conclusion
Propranolol, while effective for various medical conditions, is associated with weight gain, both in short-term and long-term use. This side effect is likely due to metabolic changes, increased appetite, and hormonal effects. Patients and healthcare providers should be aware of this potential side effect and consider alternative treatments if weight gain becomes a concern. Regular monitoring of weight and metabolic health is advisable for patients on propranolol therapy.
Sources and full results
Most relevant research papers on this topic
Long term propranolol treatment and changes in body weight after myocardial infarction.
Long-term propranolol treatment after a myocardial infarction leads to sustained weight gain, regardless of diuretic use or physical activity.
RCT
Large Human Trial
Highly CitedA Case Report with a Mini-Review of the Literature on the Overeating and Weight Gain Due to Propranolol.
Propranolol may cause increased appetite and weight gain, but these side effects are not commonly reported.
Case ReportExercise Attenuates Weight Gain And Modulates Satiety Hormones In Female Mice
Propranolol may not be the best choice for treating high blood pressure and weight loss, as it causes insulin resistance and may lead to high glucose levels in the blood.
RCT
Animal Study
Very Rigorous JournalExtreme Weight Gain due to Short-term Use of Low-dose Propranolol
Short-term use of low-dose propranolol may cause extreme weight gain due to increased appetite and reducing energy consumption.
Case ReportEffects of propranolol on changes in heart rate, heart weight, kidney weight, urinary hydroxyproline and weight gain induced by large doses of thyroxine in the rat.
Propranolol lowers heart rate but does not alter thyroxine-induced changes in peripheral metabolism, while carbimazole reduces weight gain but has no effect on heart rate or hydroxyproline excretion.
Non-RCTAnimal StudyWeight change associated with the use of migraine-preventive medications.
Weight-change effects should be considered when selecting migraine-preventive medications, and weight should be monitored carefully during treatment.
Systematic ReviewEffects of Propranolol during Pregnancy and Development of Rats. I. Adverse Effects during Pregnancy
Propranolol treatment during pregnancy in rats may result in small for dates neonates due to reduced transport across cellular membranes, potentially leading to malnutrition.
Non-RCTAnimal StudyPropranolol for infantile hemangiomas: a preliminary report on efficacy and safety in very low birth weight infants.
Propranolol effectively treats infantile hemangiomas in preterm and very low weight infants, with no adverse side effects observed and normal weight gain observed during treatment.
Escalating BMI Associated With the Complex Pharmacology of Propranolol: A Case Report
Propranolol treatment can unexpectedly lead to rapid weight gain, potentially causing obesity, and should be monitored closely for potential side effects.
Case ReportEffect of propranolol on hypophosphatemia in overweight.
Propranolol can increase serum phosphate levels in overweight hypertensive patients, potentially due to increased glucose and inorganic phosphate uptake by enlarged adipose tissue.
Non-RCT