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Medications to avoid with obese patients

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Medications to avoid with obese patients

Minimising medication-related weight gain is important in obesity management, write US endocrinologists.

In a paper, published in Gastroenterology, they underscore the need to assess the potential side effects and interactions of drugs prescribed for obese patients.

They doctors to familiarise themselves with alternatives that limit weight gain or help with weight loss.

Here is a handy list of medications that can lead to weight gain along with potential alternatives:

Medications associated with weight gain, weight neutrality and weight loss
 
  Weight gain Weight neutral/Less weight gain Weight loss
Antidiabetics Insulin, Meglitinides, Sulfonylureas, 
Thiazolidinediones
α-glucosidase inhibitors, Bromocriptine, Colesevelam, DPP-4 inhibitors   GLP-1 agonists 
Metformin
Pramlintide
SGLT2 inhibitors  
Antihypertensives α-adrenergic blockers 
β-adrenergic blockers (atenolol, metoprolol, nadolol, propranolol)
ACE inhibitors & ARBs
β-adrenergic blockers (carvedilol, nebivolol)
Calcium channel blockers
Thiazides
 
Antidepressants Lithium
MAOIs
Mirtazapine
SSRIs (paroxetine)
Tricyclics (amitriptyline, doxepin, imipramine, nortriptyline)
SSRIs (fluoxetine, sertraline) Bupropion
 
 
 
 
Antipsychotics Clozapine
Olanzapine
Quetiapine
Risperidone
Aripiprazole
Lurasidone
Ziprasidone
 
 
 
 
Antiepileptics Carbamazepine
Gabapentin
Pregabalin
Valproic acid
Lamotrigine
Levetiracetam
Phenytoin
Topiramate
Zonisamide
 
 
Contraceptives Medroxyprogesterone acetate Barrier methods
IUDs
Surgical sterilisation
 
 
 
Antihistamines 1st generation antihistamines 2nd and 3rd generation antihistamines
Alternatives: decongestants
 
 
Steroids Glucocorticoids Inhaled steroids
Topical steroids
Alternatives: NSAIDs, DMARDs
 
 
 

DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon-like peptide-1; SGLT2, sodium-glucose co-transporter 2; ACE, angiotensin-converting enzyme; ARB, Angiotensin II receptor blockers; MAOI, monoamine oxidase inhibitor; SSRI, selective serotonin reuptake inhibitor; IUD, intrauterine device; NSAID, non-steroidal anti-inflammatory drug; DMARD, disease modifying antirheumatic drug

Adapted from: Saunders KH, Igel LI, Shukla AP, et al. Drug-induced weight gain: Rethinking our choices. J Fam Pract 2016; 65:780-82,784-86,788.

Apovian CM, Aronne L, Powell AG. Clinical management of obesity. West Islip (NY): Professional Communications, Inc; 2015. p 148-50

You can read the study here.

 

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