How many medications are you on? Do any of those medications make you gain weight? If not outright weight gain, do any of those medications make it difficult to lose weight? You might be surprised at the following list

This list is compiled from a lecture at an obesity conference which I attended*. Although careful when I prescribe medications to my overweight patients, some of the medications on this list were a surprise to me.

Diabetes Medications

Insulin

In people with Type 2 Diabetes (Adult Onset Diabetes Mellitus), insulin is notorious for causing weight gain. Insulin makes you hungry. You eat. You gain weight. The more weight you gain, the more insulin you need over time. It is a vicious cycle.

If you have Type 2 Diabetes, and are overweight, and are on insulin, you might be able to wean yourself off the insulin. It is a huge project. You need to be very vigilant about what and how much you eat. Don’t do this at home without direction. You will need very close supervision by your physician.

Thiazolidinediones (TZD’s )

Actos® (Pioglitazone) and Avandia® (Rosiglitazone) are the only two medications in this class of medications used to treat diabetes. Avandia® recently had some bad press. If you are on a TZD, you are probably on Actos®. TZD’s cause a bit of weight gain. Don’t stop your Actos® yet! The medications in this class have a very important role in controlling blood sugar. They may also help to decrease the amount of fat in your liver and belly, which is a very good thing. If you are serious about losing weight, there are other medications for diabetes to consider. Byetta®, Victoza®, and Glucophage® all help people lose a bit of weight. Januvia® is another medication, but it has no effect on weight.

Sulfonylureas

These medications stimulate the pancreas to secrete insulin. This is a double edge sword. First of all, insulin makes people hungry. That is what insulin does, so, people gain weight. Secondly, under normal conditions in healthy people, insulin secretion is coordinated with your meals. When you eat, you pancreas secretes insulin. If you take a sulfonylurea, your pancreas secretes insulin off-schedule. If your stomach is empty when your pancreas secretes insulin, your blood sugar drops. Then, you become light-headed and need to eat a candy to bring your sugars back up. People end up gaining weight in the long run. Medications in this class include Glucotrol® (glipizide), Diabinase® (chlorpropamide), Diabeta® (glyburide) and Micronase® (also glyburide). Many physicians have stopped prescribing Sulfonylureas. There are better medications now for the treatment of diabetes.

No matter what medications you take for your diabetes, what and how much you eat are the keys to controlling your blood sugar in Type 2 Diabetes.

Beta-Blockers

These medications are used to treat hypertension (high blood pressure.) Beta-blockers also slow down how fast you heart beats. For people whose heart rate is too fast, for example people with atrial fibrillation, these medications are used to slow the heart down. This class of medication is also used in congestive heart failure, and to prevent migraine headaches. If you have atrial fibrillation and are on a beta-blocker, well, there isn’t much you can do. You need to stay on your beta-blocker.  On the other hand, if you are on a beta-blocker for hypertension, there are many other medications that do a better job at controlling blood pressure, without causing weight gain.

Psychiatric Medications

One could write a book on this subject alone because there are so many psychiatric medications that cause weight gain. Lithium, valproic acid, anti-psychotics and tricyclic anti-depressants all can cause weight gain. Lithium is used for people with Bipolar Disease (manic-depression.) Valproic acid is a mood stabilizer used in depression. Anti-psychotics are notorious for causing weight gain, especially Zyprexa®.

If not outright weight gain, these medications make it difficult to lose weight. If you are on any of these medications and are obese, work with your psychiatrist to try a different medication. Of course, this is easier said than done. Many of my patients are on psychiatric medications. No one wants to try something different. Each one is so happy to have their depression, or mania, or hallucinations controlled. I can’t blame them for being reluctant to change.

Antihistamines

A little know fact about antihistamines is that they can cause weight gain. HIV-treating physicians know this fact. We prescribe an antihistamine, cyproheptadine (Periactin®), to our patients who need to gain weight.

During allergy season, you are between a rock and a hard spot. You need your antihistamine to control your sneezing and stuffy sinuses. If you can’t do without, the least you can do is avoid overuse of your anti-histamines.

Birth Control Injections

Birth control injections can cause weight gain.  Again, you are between a rock and a hard spot. You need a form of birth control. On the other hand, if you are overweight or obese and are gaining weight from the injections, think about an alternative form of contraception.

Prednisone

People who take prednisone for asthma or for an autoimmune disease will tell you how hungry they become after a dose. If you have a disease which requires prednisone therapy, you may have no other options.

Prednisone is life saving for people with severe asthma. There are all kinds of inhalers that help prevent asthma attacks, but when a severe asthma attack strikes, prednisone is the answer. If you have frequent asthma attacks, get to a pulmonologist. Maybe a different set of inhalers can prevent some of the exacerbations.

For some autoimmune diseases, there are new medications called “immune modulators.” These might be an option for some people with diseases like Rheumatoid Arthritis.

Whether you take prednisone for asthma or for an autoimmune disease, take the lowest possible dose, and explore other treatment options.

Opiates

People who need to take high doses of opiates for pain will notice a slow and steady weight gain over time. If you have a chronic pain condition, you need to be under the care of a pain specialist or a physiatrist (a physician who specializes in Rehabilitation Medicine.) Pain is so difficult to treat, but there are other options now. Epidural injections, nerve blocks, implantable stimulators, can all help lessen the pain. There are adjuvant medications, i.e., medications used in addition to the opiates, which can also help lessen the pain by calming nerve-endings. A multi-faceted approach might help you to lower the dose of your opiates. Obviously, you don’t want to be on opiates forever, and you don’t want to be in pain for the rest of your life either. In any event, if you are overweight or obese and are on long-term opiate therapy, it’s time to try a different approach.

* The lecture was given by Norman Sussman, M.D., a clinical professor of Psychiatry at New York University Medical Center.

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