Table 11. Non-weight management pharmaceuticals that that may affect body weight.*1-6
Class / Agent Effect upon body weight
Cardiovascular pharmacotherapies Some betablockers (e.g propranolol, atenolol, metoprolol) ↑ Dihydropyridine (“dipine”) calcium channel blockers (e.g. nifedipine, amlodipine, felodipine) ↑
Diabetes mellitus pharmacotherapies Most insulins ↑ Sulfonylureas ↑ Thiazolidinediones ↑ Meglitinides ↑ Metformin ↓ -- Glucagon-like peptide-1 agonist ↓ Alpha glucosidase inhibitors (e.g. acarbose, miglitol) ↓ Pramlintide ↓ Sodium glucose co-transporter 2 inhibitors ↓
Hormones Glucocorticoids ↑ Estrogens ↑ Progestins ↑
Antidepressants Tricyclic antidepressants – tertiary amine (e.g. amitriptyline, doxepin, imipramine, trimipramine) ↑ Tricyclic antidepressants – secondary amine (e.g. desipramine, nortriptyline, protriptyline) ↑--- ↓ Irreversible monoamine oxidase (MAO) inhibitors Isocarboxazid, phenelzine ↑ Tranylcypromine ↑--- ↓ Selective serotonin reuptake inhibitor antidepressants (e.g. paroxetine) ↑ Selective serotonin reuptake inhibitor antidepressants (e.g. not paroxetine – citalopram, escitalopram, ---↑ fluoxetine, sertraline) Serotonin and norepinephrine reuptake inhibitors (e.g. desvenlafaxine, duloxetine, venlafaxine) ---↑ Bupropion ↓ Mirtazapine ↑
Hypnotics Diphenhydramine ↑ Benzodiazepines, non-benzodiazepine and melatonergic hypnotics, and trazodone ---
Antihistamines Diphenhydramine ↑ Cyproheptadine ↑ Antipsychotics Clozapine, olanzapine, zotepine ↑↑ Asenaprine, chlopromazine, haloperidol, iloperidone, ioxapine, paliperidone, quetiapine, risperidone, ↑ sertindole, lithium Amisulpride, aripiprazole, lurasidone, ziprasidone --- Mood Stablizers Gabapentin ↑ Lithium ↑ Valproate ↑ Vigabatrin ↑ Carbamazepine ---↑ Lamotrigine ---↑ Oxcarbazepine ---
Migraine Medications Topiramate ↓ Amitriptyline, gabapentin, paroxetine, valproic acid ↑
Antizeizure drugs Carbamazepine ↑ Gabapentin ↑ Valproate ↑ Lamotrigine ↓ Topriamate ↓ Zonisamide ↓
Anti-viral agents Some highly active antiretroviral therapy (HAART) protease inhibitors without HIV lipodystrophy ↑ Some highly active antiretroviral therapy (HAART) protease inhibitors with HIV lipodystrophy ↓
Chemotherapeutic agents Tamoxifen ↑ Cyclophosphamide ↑ Methotrexate ↑ 5-Fluorouracil ↑ Aromatase inhibitors ↑
Serotonin antagonists Pizotifen ↑
*Pharmacologic increase in body weight may not always worsen dyslipidemia. For example, insulin or pioglitazone treatment of a patient with poorly controlled diabetes mellitus may improve dyslipidmemia.
1Caroline M. Apovian (chair) LJA, Daniel H. Bessesen, Marie E. 7 McDonnell, Mohammad Hassan Murad, Uberto Pagotto, Donna H. Ryan, Christopher D. Still http://www. endocrine.org/~/media/endosociety/Files/Advocacy%20and%20Outreach/Clinical%20Practice%20Guidelines/Obesity%20Guideline%20member%20comment.pdf Draft Title: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice 1 Guideline. May 15, 2014. 2Bostwick JM. A generalist’s guide to treating patients with depression with an emphasis on using side effects to tailor antidepressant therapy. Mayo Clinic proceedings. Mayo Clinic. 2010;85:538-550. 3Hasnain M, Vieweg WV, Hollett B. Weight gain and glucose dysregulation with second-generation antipsychotics and antidepressants: a review for primary care physicians. Postgraduate medicine. 2012;124:154-167. 4Hasnain M, Vieweg WV. Weight considerations in psychotropic drug prescribing and switching. Postgraduate medicine. 2013;125:117-129. 5Perez-Iglesias R, Crespo-Facorro B, Martinez-Garcia O, et al. Weight gain induced by haloperidol, risperidone and olanzapine after 1 year: findings of a randomized clinical trial in a drug-naive population. Schizophrenia research. 2008;99:13-22. 6Leucht S, Cipriani A, Spineli L, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet. 2013;382:951-962.