Medications Associated with Weight Gain

Aka: Medications Associated with Weight Gain, Medications that Exacerbate Obesity

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II. Preparations: Endocrine Agents

  1. Diabetes medications
    1. Most weight gain
      1. Insulin (associated with 8-15 weight gain)
      2. Sulfonylureas (e.g. Glyburide, Glipizide, associated with 5 pound weight gain)
      3. Thiazolidinediones (e.g. Pioglitazone/Actos, associated with 5 pound weight gain)
      4. Meglitinides
    2. Least weight gain
      1. Gliptins (DPP-4 Inhibitor, such as Sitagliptin)
      2. Glimepiride
    3. Weight loss
      1. GLP-1 Agonist (e.g. Liraglutide, exanitide)
      2. Alpha-Glucosidase Inhibitor (e.g. Acarbose, Precose)
      3. Glucophage (Metformin)
      4. Pramlintide (Symlin)
  2. Other endocrine agents associated with weight gain
    1. Tamoxifen
    2. Steroid Hormones
    3. Glucocorticoids and Corticosteroids
    4. Progestational steroids

III. Medications: Psychotropics

  1. Miscellaneous agents associated with weight gain
    1. Phenothiazines
  2. Mood Stabilizers
    1. Most weight gain
      1. Lithium
    2. Least weight gain
      1. Oxcarbazepine (Trileptal)
  3. Selective Serotonin Reuptake Inhibitors (SSRI)
    1. Weight gain is associated with Histamine H1 receptor blockade
    2. Most weight gain
      1. Mirtazapine (Remeron, averages 6 pound weight gain)
      2. Paroxetine (Paxil, averages 6 pound weight gain)
    3. Least weight gain or weight loss
      1. Fluoxetine (Prozac)
      2. Sertraline (Zoloft)
      3. Citalopram (Celexa) or Escitalopram (Lexapro)
      4. Venlafaxine (Effexor) or Desvenlafaxine (Pristiq)
    4. Weight loss
      1. Bupropion (Wellbutrin, averages 6 pound weight loss)
  4. Monoamine Oxidase Inhibitors
    1. Most weight gain
      1. Phenelzine
    2. Least weight gain
      1. Tranylcypromine
  5. Tricyclic Antidepressants
    1. Most weight gain
      1. Amitriptyline
      2. Imipramine
      3. Nortriptyline
    2. Least weight gain
      1. Desipramine
      2. Protriptyline
  6. Atypical Antipsychotics
    1. Most weight gain
      1. Olanzapine (Zyprexa) has the highest risk (7% weight gain in one third of patients)
      2. Risperidone
      3. Clozapine
      4. Quetiapine (Seroquel)
    2. Least weight gain (Atypical Antipsychotics)
      1. Aripiprazole (Abilify)
      2. Ziprasidone (Geodon)
      3. Lurasidone (Latuda)
      4. Paliperidone (Invega)
      5. Asenapine (Saphris)

IV. Medications: Neurologic Agents

  1. Anticonvulsants
    1. Most weight gain
      1. Valproic Acid (50% of patients gain 10% body weight)
      2. Gabapentin (Neurontin, 25% of patients gain 10% body weight)
      3. Pregabalin (Lyrica)
      4. Carbamazepine (Tegretol)
    2. Least weight gain
      1. Lamotrigine (Lamictal)
      2. Levetiracetam (Keppra)
      3. Phenytoin (Dilantin)
    3. Associated with weight loss
      1. Topiramate (may cause up to 15 lb weight loss in 6 months)
      2. Zonisamide (may cause up to 15 lb weight loss in 6 months)
      3. Felbamate (Felbatol)

V. Medications: Cardiovascular Agents

  1. Antihypertensives
    1. Most weight gain
      1. Alpha adrenergic blockers (consider Doxazosin instead)
      2. Beta adrenergic blockers (esp. Propranolol) - less with selective Beta Blockers
      3. Calcium Channel Blockers (Felodipine, Nifedipine)
    2. Least weight gain
      1. ACE Inhibitors
      2. Angiotensin Receptor Blockers

VI. Preparations: Miscellaneous

  1. Highly Active Antiretroviral Therapy
  2. Diphenhydramine (Benadryl)

VII. References

  1. Erlandson (2016) Am Fam Physician 94(5): 361-8 [PubMed]
  2. Malone (2005) Ann Pharmacother 39(12): 2046-55 [PubMed]

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