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Can Prescription Drugs Lead to Weight Gain?

Medically reviewed on Aug 13, 2018 by L. Anderson, PharmD

Can Some Medications Can Cause Me to Gain Weight?

Unfortunately, the answer to this question is yes. Weight gain due to medications can be just a few pounds, or it can be a more serious weight gain.

For example, some drugs that decrease inflammation like prednisone or methylprednisolone might lead to a 50 pound weight gain or more, often in the storage of fat.

In addition, weight gain from medications can worsen, or even cause, medical conditions such as:

How Do Medications Cause Weight Gain?

Weight gain can be a slow process, whether it be from drugs, food, or lack of exercise.

Exactly what causes the weight gain due to a medication is not always known.

  • Some medications can increase hunger or lead to fluid and water retention.
  • Drugs that trigger an increase in appetite may work in the brain and change the satiety (feeling full) center.
  • Some medications may slow you down and lead to a less active lifestyle, resulting in added pounds.

It is often difficult to tell the difference between weight gain from a drug and weight gain from other reasons.

What Are The Risks Associated With Medication-Related Weight Gain?

The risks can be serious.

Weight gain may increase the chance for:

If a rapid weight gain occurs in a short period of time, a physician should be contacted for evaluation, especially if a patient has a risk for heart disease or high blood pressure.

Some drugs will need to be stopped slowly, as stopping them quickly may lead to serious side effects. You should not stop taking any medication without first talking to your doctor.

What Can Be Done About Weight Gain With Medications?

If a patient is concerned about weight gain due to their medications, they should contact their health care provider. It may be possible to change to a different drug. Even similar medications in the same drug class can lead to very different side effects.

Medications can affect each patient differently, too - not every patient will gain weight, even if it is listed as a side effect of the drug. However, in some cases, patients will need to increase their level of exercise and adjust their diet.

Can Antidepressant Drugs Lead To Weight Gain?

Older antidepressants known as tricyclic antidepressants (TCAs) are known for increasing appetite and causing weight gain.

The selective serotonin reuptake inhibitor (SSRI) class is usually weight neutral, but some drugs in this class can cause weight gain. A physician can choose among many alternatives in the antidepressant class to minimize weight gain. MIrtazapine (Remeron), an atypical antidepressant may cause significant weight gain.

Antidepressants are not always the direct cause of weight gain -- lack of exercise, altered sleep habits, unhealthy food choices, and changes in eating habits due to depression may result in added weight, too.

Which Antidepressants Are Known To Cause Weight Gain?

Tricyclic antidepressants have been associated with weight gain - common culprits include:

Most SSRIs are weight neutral. For example:

  • fluoxetine (Prozac) - one meta-analysis linked fluoxetine with a weight loss of 1.3 kg (2.9 lbs).
  • sertraline (Zoloft)
  • venlafaxine (Effexor)
  • duloxetine (Cymbalta)

However, certain SSRIs like paroxetine (Paxil) may be more likely to lead to weight gain than other SSRIs, although it may be modest.

The atypical agent mirtazapine (Remeron) is linked weight gain, roughly 1.5 kg (3.3 lbs), on average.

Bupropion (brand names include Forfivo XL, Wellbutrin SR, Wellbutrin XL) is an atypical antidepressant that is linked with weight loss as a side effect. One study found a average weight loss of 1.3 kg (2.9 lbs). Bupropion is also found in the smoking cessation agent Zyban.

Do Antihistamines Lead To Weight Gain?

It is well known that antihistamines can lead to weight gain. In fact, one antihistamine -- cyproheptadine -- is used specifically for this purpose. However, most people do not want added weight with use of an antihistamine.

Antihistamines, such as:

block histamine receptors. These drugs can be bought without prescriptions and have been associated with weight gain. Antihistamine activity can boost appetite, as noted with several other drugs that cause weight gain, like some antidepressants.

Studies have shown that some H1 antihistamines may increase weight, body mass index, waist circumference, and insulin levels. For many patients, the allergy benefit with antihistamines outweighs any slight weight gain risk.

Do Antipsychotics Cause Weight Gain?

Many antipsychotics are known for their ability to lead to weight gain. Atypical antipsychotics can lead to changes in metabolism and increase the risk for diabetes and high cholesterol. In a meta-analysis looking at the effect of various drugs on weight, the atypical antipsychotic class was linked with the most weight gain.

Antipsychotic medications are often used for bipolar disorder and schizophrenia, and patients can gain from 7% to 10% of their body weight.

The common atypical antipsychotics

have all been linked to significant weight gain, with clozapine and olanzapine having the highest risk. On average, weight gains have been reported as: olanzapine (2.4 kg, 5.2 lbs), quetiapine (1.1 kg, 2.4 lbs), and risperidone (0.8 kg, 1.8 lbs) in a median of 3 months time.

Asenapine (Saphris), iloperidone (Fanapt), paliperidone (Invega), quetiapine (Seroquel), risperidone (Risperdal) are ranked in the middle for weight gain, with aripiprazole (Abilify), lurasidone (Latuda), and ziprasidone (Geodon) having the lowest risk, according to a study by Musil, et al.

Certain drugs may also block histamine activity and affect serotonin which may contribute to the mechanism of weight gain. In addition, mental disorders like schizophrenia are known to cause weight gain, as well, and this may be a contributing factor.

Can Antipsychotics Affect Blood Sugar?

Antipsychotics may impair glucose (blood sugar) control and lead to insulin resistance, impaired glucose tolerance and a higher risk for type 2 diabetes.

However, these drugs are often absolutely needed for treatment of conditions like bipolar disorder or schizophrenia, and patients must speak with their physician before stopping or changing treatment.

Ziprasidone (Geodon) and aripiprazole (Abilify) are more weight neutral antipsychotics, but may still increase blood sugar.

Can Blood Pressure Medications Cause Weight Gain?

Beta-blockers are a frequently used class of drug for blood pressure, and they are affordable, too. However, many beta-blockers are linked with weight gain.

Common examples of this class that may expand the waist include:

  • metoprolol
  • atenolol
  • propranolol

Many of the older beta-blocker drugs may slow down activity in general, which may be responsible for some of the weight gain. Patients may be tired, have lack of energy, and feel fatigued, which may affect their ability to stay active and exercise. This can lower the number of calories burned each day.

Can Corticosteroids Increase Appetite?

Oral corticosteroids (glucocorticoids) are drugs such as:

  • prednisone
  • methylprednisolone
  • hydrocortisone

Corticosteroids are used for severe asthma, acute allergies or inflammatory disorders such as arthritis. These drugs can boost the metabolic rate and the appetite, too. High doses and long-term use of these agents may carry a significant risk of weight gain.

Local injectable corticosteroids (for example, used for knee pain) and inhaled corticosteroids used for asthma are not associated with weight gain.

It's a Catch 22: Diabetes Drugs and Weight Gain

Putting on weight is the last thing someone with type 2 diabetes wants to do; it can lead to -- or worsen -- insulin resistance and overall diabetes control.

However, the type 2 diabetes drugs:

  • glyburide (DiaBeta)
  • glipizide (Glucotrol)

both from an older diabetes drug class, can lead to significant weight gain. These agents may increase insulin production, which can lower blood sugar and increase appetite. Injectable insulin can also lead to weight gain.

Other drugs used in the treatment of type 2 diabetes, such as the thiazolidinediones -- pioglitazone (Actos) and rosiglitazone (Avandia) -- may lead to weight gain and fluid (water) retention.

The meglitinides such as nateglinide (Starlix) and repaglinide (Prandin) are also linked with weight increases, roughly 1 kg (2.2 lbs) to 3 kg (6.6 lbs) over a 4 to 6 month study period.

Which Diabetes Drugs Are Less Likely to Cause Weight Gain?

Luckily, there are several diabetes medications that may not add on unwanted pounds.

Metformin (Glucophage) and sitagliptin (Januvia), type 2 diabetes drugs, may either not affect weight or be associated with weight loss. However, a recent meta-analysis did find a slight weight increase (~0.5 kg or 1.1 lb) with sitagliptin.

Glucagon-like peptide-1 (GLP-1) receptor agonists slow digestion in the stomach, but can lead to nausea and vomiting. They are given by injection. These drugs have been shown to lead to modest weight loss, even in patients without diabetes. However, the 3 brands listed below are not specifically approved for weight loss.

Saxenda is the brand name of liraglutide approved to help with weight loss, along with diet and exercise, but is not used in treating type 1 or type 2 diabetes. Be sure you do not use Saxenda and Victoza together.

The alpha-glucosidase inhibitors miglitol (Glyset) and acarbose (Precose) were shown to be linked with a 0.7 kg (1.5 lb) and 0.4 kg (0.9 lb) weight loss, respectively, in a meta-analysis evaluating weight changes with medications. These drugs may help with a modest weight loss in patients with diabetes.

Pramlintide (Smylin), an amylin analog, has also been reported to lead to a weight loss of 2.3 kg (5 lb) in a large meta-analysis from Domecq and colleagues. Amylin analogs help control blood sugar by inhibiting glucagon secretion, delaying gastric emptying, and signaling the feeling of fullness, which suppresses the intake of food.

Seizure Drugs and Mood Stabilizers Can Add Pounds

Drugs for seizures and bipolar disorder are important medications for serious conditions, and patients should discuss the issue of weight gain with their doctor before stopping or changing any medications.

Valproic acid (Depakote, Depakene) is used to treat epilepsy (seizures) and bipolar disorder, and is also used for migraine prevention. Valproic acid appears to boost appetite and may result in a 4.5 kg (10 lb) or more weight gain.

A meta-analysis showed that gabapentin (Neurontin, Gralise) was associated with a weight gain of 2.2 kg (4.8 lbs) after 1.5 months of use.

Lithium and lamotrigine were not associated with a statistically significant effect on weight; therefore, they may be weight neutral.

However, in the same meta-analysis from Domecq, significant weight loss was noted with zonisamide (Zonegran) of 7.7 kg (17 lbs), an anti-convulsant drug, and topiramate (Topamax) of 3.8 kg (8.4 lbs), used for seizures and for migraine prevention.

What Should I Do If I Think My Medication Is Causing Weight Gain?

If your weight increases after starting a medication, talk to your doctor about the benefits and risks of using the drug, and if it's linked with weight gain.

It may be that the drug is not the cause of the weight gain, but your diet and exercise may need boosting. Your doctor can give you advice on how to control the weight, including exercise and diet tips.

If a change in your medication is needed, there may be another drug your doctor can prescribe -- amybe even in the same class of drug -- that will work just as well, but not increase your weight.

Finished: Can Prescription Drugs Lead to Weight Gain?

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Sources

  • Domecq JP, Prutsky G, Leppin A, et al. Drugs Commonly Associated With Weight Change: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. 2015 Feb; 100(2): 363–370. Accessed August 14, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393509/.
  • Musil R, Obermeier M, Russ P, et al. Weight gain and antipsychotics: a drug safety review. Expert Opin Drug Saf. 2015 Jan;14(1):73-96. Accessed August 14, 2918 at https://www.ncbi.nlm.nih.gov/pubmed/25400109.
  • Fields T. Hospital for Special Surgery. Steroid Side Effects: How to Reduce Corticosteroid Side Effects. Accessed August 14, 2018 at https://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp
  • Antihistamines and weight gain. Ask the Expert. American Academy of Allergy, Asthma & Immunology. Accessed August 14, 2018 at https://www.aaaai.org/ask-the-expert/antihistamines-weight-gain
  • Ratliff J, Barber J, Palmese L, et al. Association of prescription H1 antihistamine use with obesity: Results from the National Health and Nutrition Examination Survey. Obesity (Silver Spring, Md). 2010;18(12):2398-2400. doi:10.1038/oby.2010.176. Accessed August 14, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221329/
  • Weight Control Information Network (NIDDK) - Overweight and Obesity Statistics. 11/2012. Accessed August 14, 2018 at. http://win.niddk.nih.gov/statistics/index.htm#b
  • Cheskin L, et al. Prescription medications: a modifiable contributor to obesity. South Med J. 1999;92:898-904. Accessed August 14, 2018 at http://www.ncbi.nlm.nih.gov/pubmed/10498166

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