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107. Weight Gain Meds
Rio Bravo qWeek
English - August 19, 2022 12:00 - 14 minutes - 13.1 MBMedicine Health & Fitness Mental Health kern medical rio bravo medical discussion rio bravo qweek medical residency weekly medical info qweek residency podcast Homepage Download Google Podcasts Overcast Castro Pocket Casts RSS feed
Episode 107: Weight Gain Meds.
Medications that cause weight gain are also called weight positive medications. Sapna, Danish, and Dr. Arreaza mention some of those medications in this episode.
Introduction: Some meds cause weight gain
By Hector Arreaza, MD.
You will see patients who keep gaining weight regardless of their sincere efforts to eat better and exercise. Some people experience serious difficulties to lose weight. If you want to know how frustrating it can be, imagine your doctor telling you to add one more inch to your height when you are 35 years old. For some people, losing weight is just as hard. One important step you can take to help your patients lose weight is performing a detailed medication reconciliation. Review the medication list, and you may find some meds that are proven to cause weight gain. Today we will discuss some of those medications, but it takes practice to learn all of them. I hope this episode is helpful for you.
This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.
This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.
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Weight Gain Meds.
By Sapna Patel, MS4, and Danish Khalid, MS4. Ross University School of Medicine. Comments by Hector Arreaza, MD.
S: Medications associated with weight gain: See Table 1.1 for medications associated with weight gain and alternatives.
Antipsychotic agents:
A: Ziprasidone is an antipsychotic medicine that causes the least amount of weight gain.
Antidepressants:
Antiepileptics/Antiseizure:
Amongst the antiepileptic drugs used to treat seizures, neuropathic pain, or other psychiatric conditions, valproate, carbamazepine, and gabapentin are associated with weight gain. Gabapentin is virtually used by all our diabetic patients.
Antihypertensive agents: Beta Blockers
Hypoglycemic medications:
Although intended to regulate blood sugar levels, several anti-diabetic medications are associated with weight gain, specifically sulfonylureas, Actos, and insulin. As mentioned earlier, metformin as well as GLP-1 agonists are associated with weight loss. Metformin can be considered weight neutral.
Steroids:
Antihistamine Medications:
Diphenhydramine (Benadryl): commonly used for allergies…or how my mom used it, puts you to sleep right before a flight. However, a side effect of using this medication includes weight gain.Cyproheptadine: an antihistamine, used for antidote to serotonin syndrome and migraines, has an appetite stimulant effect causing weight gain. It can be used off-label as an appetite stimulant in children who do not gain weight.
Fun Fact: Although it is a common belief that combined oral contraceptives cause weight gain, data suggest that significant weight gain is not a common side effect of combined oral contraceptives.
A good practice: Medication reconciliation: Weight positive, weight neutral, or weight negative.
Weight positive: Deprescribe or change for another medication if possible. Weight neutral and weight negative: Keep them. Don’t be afraid to prescribe anti-obesity meds. We should learn about them, become familiar with side effects, contraindications, dosing, and more, and prescribe them appropriately as part of a weight loss program. Also, don’t forget that these medications are used in conjunction with a proper diet.
Category
Drug Class
Weight Gain
Alternatives
Psychiatric agents
AntipsychoticsClozapine, risperidone, olanzapine, quetiapine, haloperidol, perphenazineZiprasidone, aripiprazoleAntidepressants/mood stabilizers: tricyclic antidepressantsAmitriptyline, doxepin, imipramine, nortriptyline, trimipramine, mirtazapine
Bupropion, nefazodone, fluoxetine (short term), sertraline (<1 year)
Antidepressants/mood stabilizers: SSRIsSertraline, paroxetine, fluvoxamineAntidepressants/mood stabilizers: MAOIsPhenelzine, tranylcypromineLithiumNeurologic agents
Anti-seizure medicationsCarbamazepine, gabapentin, valproateLamotrigine, topiramate, zonisamideEndocrinologic agents
Diabetes drugsInsulin (weight gain differs with type and regimen used), sulfonylureas, thiazolidinedionesMetformin, acarbose, miglitol, pramlintide, exenatide, liraglutideCardiologic agents
AntihypertensivesBeta-blockerACE inhibitors, calcium channel blockers, angiotensin-2 receptor antagonists
General
Steroid hormonesCorticosteroids, progestational steroidsNSAIDsAntihistamines/anticholinergicsDiphenhydramine, doxepin, cyproheptadineDecongestants, steroid inhalersTable 1.1: Medications associated with weight gain and alternatives.4
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Conclusion: Now we conclude our episode number 107 “Weight Gain Meds.” Sapna and Danish did an excellent job in this episode. Performing a good medication reconciliation is a key element in a weight loss visit. Some patients cannot stop taking medications that cause weight gain, also called weight-positive medications. I recommend you be cautious when discontinuing any medication. If you are not the prescriber, consult with the prescriber to discuss the possibility to lower the dose, finding an alternative medication, or determining if the medication can be discontinued. If none of those options are feasible, you may consider starting metformin if not contraindicated, I hope you learned something new today.
This week we thank Hector Arreaza, Sapna Patel, Danish Khalid, Valerie Civelli, and Arianna Lundquist. Audio edition by Adrianne Silva.
Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at [email protected], or visit our website riobravofmrp.org/qweek. See you next week!
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References:
References:
Perreault, L., Apovian, C. (2021). Obesity in adults: Overview of management. Pi-Sunyer, F.X., Seres, D., & Kunins, L. (Eds.) UpToDate. Available from: https://www.uptodate.com/contents/obesity-in-adults-overview-of-management.Perreault, L. (2022). Obesity in adults: Drug therapy. Pi-Sunyer, F.X., & Kunins, L. (Eds.) UpToDate. Available from: https://www.uptodate.com/contents/obesity-in-adults-drug-therapy.
Dungan, K., DeSantis, A. (2022) Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. Nathan, D.M., & Mulder, J.E. (Eds.) UpToDate. Available from: https://www.uptodate.com/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus
Perreault, L., Bessesen, D. (2022). Obesity in adults: Etiologies and risk factors. Pi-Sunyer, F.X., & Kunins, L. (Eds.) UpToDate. Available from: https://www.uptodate.com/contents/obesity-in-adults-etiologies-and-risk-factors