Medications play a pivotal role in managing various health conditions but can sometimes lead to unintended side effects such as weight gain or weight loss. This comprehensive article aims to shed light on the wide range of medications associated with metabolic and other physical changes, exploring the mechanisms behind these effects and offering guidance on management strategies.

Key Takeaways:

1. Many medications across various therapeutic classes, including psychiatric medications, antidiabetic drugs, cardiovascular drugs, hormonal medications, and antiepileptic drugs, can contribute to weight changes.

2. The mechanisms behind these metabolic changes are multifaceted and may include mood changes, increased appetite, increased energy expenditure, alterations in metabolism and hormone levels, and sometimes fluid retention.

3. Effective management includes regular monitoring of labs and body composition, lifestyle modifications (nutrition and physical activity), and reviewing medication regimens for possible adjustments or switches to alternatives with lower weight gain potential.

4. Management should be individualized, taking into account the patient's overall health, risk versus reward, the necessity of the medication, and the feasibility of switching to less impactful alternatives. An integrated approach, involving nutritionists, therapists, and psychiatric providers, can be beneficial.

The article emphasizes the importance of awareness, proactive management, and the availability of strategies to mitigate the impact of medication-induced metabolic changes on patients' health and quality of life.

Introduction

Navigating the complex interplay between medications and metabolism is crucial for healthcare providers and patients alike. Understanding which medications can lead to weight changes is the first step in mitigating this common side effect, thereby improving patient outcomes and adherence to treatment. Here, we delve into a detailed examination of medications known to influence weight changes, their mechanisms of action, and strategies for effective management.

Medications Associated with Weight Gain

A wide array of medications across different therapeutic classes can contribute to weight changes. These include, but are not limited to:

Psychiatric Medications

• Antipsychotics: Such as olanzapine, clozapine, risperidone, quetiapine, and aripiprazole. These medications can significantly increase appetite by down-regulating multiple receptor sites and impairing overall glucose metabolism leading weight gain.

• Mood Stabilizers: Lithium, carbamazepine, and valproate are notable examples, often leading to weight gain through metabolic changes and increased appetite. Lamotrigine and oxcarbazepine are not typically associated with weight changes, but gabapentin may contribute to water retention.

• Antidepressants: Those with the highest risk of weight gain include amitriptyline, citalopram, mirtazpine, nortriptyline, paroxetine, and amitriptyline. Long term use of even the newest serotinergic agents can down-regulate receptors causing cravings for carbohydrate rich foods.

Antidiabetic Medications

• Insulin: Essential for managing diabetes but can cause weight gain due to its anabolic effects and the reduction of glycosuria.

• Sulfonylureas: Such as glipizide and glyburide, which increase insulin levels and can stimulate appetite.

• Thiazolidinediones: Pioglitazone and rosiglitazone may lead to weight gain and fluid retention by promoting fat storage.

  (Of note, metformin, GLP-1 agonists, and multiple lifestyle interventions are correlated with weight loss)

Cardiovascular Drugs

• Beta-Blockers: Including propranolol (commonly used for anxiety), metoprolol, and atenolol, can slow metabolism and increase fat accumulation.

• Calcium Channel Blockers: Certain agents like amlodipine may contribute to weight gain in some patients, though mechanisms are less clear.

Hormonal Medications

• Corticosteroids: Prednisone and methylprednisolone can lead to increased appetite and changes in fat distribution, particularly increased visceral fat.

• Oral Contraceptives and Hormone Replacement Therapy: May cause weight gain or changes in body composition in some individuals.

Other Notable Medications

• Certain antihypertensive medications: Such as clonidine and minoxidil.

• Immunosuppressants: Such as ciclosporin and tacrolimus.

• Antiviral drugs for HIV: Protease inhibitors and some nucleoside reverse transcriptase inhibitors have been linked to weight gain and lipodystrophy.

• Antihistamines: Such as Benadryl (diphenhydramine).

Mechanisms Behind Medication-Induced Weight Gain

The mechanisms by which medications induce weight gain are varied and can include increased appetite, decreased energy expenditure, alterations in metabolism and hormone levels, fluid retention, and down-regulation of receptor sites. For instance, antipsychotics may increase weight by blocking dopamine receptors, which in turn affects the hypothalamic pathways controlling appetite. Similarly, insulin and sulfonylureas increase weight through their anabolic effects and by reducing glycosuria, leading to calorie retention.

Managing Medication-Induced Weight Gain

Management strategies need to focus on a multidisciplinary approach, including:

• Regular Monitoring: Tracking labs, blood pressure, mood, and body composition changes over time.

• Lifestyle Modifications: Reviewing nutrition, physical activity, social connection, and sleep before implementing behavioral changes.

• Medication Review: Discuss with your provider alternative treatments like metformin, GLP-1 agonists, and multiple lifestyle interventions in addition to adjusting dosages as necessary.

Conclusion

Awareness and proactive management of medication-induced weight gain are essential for minimizing health risks and ensuring optimal treatment outcomes. Through careful medication selection and lifestyle interventions, it is possible to mitigate the impact of these side effects, enhancing patient well-being and adherence to therapy. Check out the Supervised Lifestyle and Integrate Medicine (SLIM) Group for one option to help with behavioral changes. Your psychiatric provider, therapist, and nutritionist are here to guide you on your journey.

Sources

Anekwe, C. (2022, July 18). Managing weight gain from psychiatric medications. Harvard Health Blog. https://www.health.harvard.edu/blog/managing-weight-gain-from-psychiatric-medications-202207182781

University of Rochester Medical Center. (n.d.). When your weight gain is caused by medicine. Health Encyclopedia. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contentid=DM300&contenttypeid=56

Verhaegen, A. A., & Van Gaal, L. F. (2019). Drugs that affect body weight, body fat distribution, and metabolism. In NCBI Bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537590/