Medication and Weight Gain

Apr 16, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

My son Eric and I went for supper at Montanas in Brandon. We probably should have gone for fast food because Eric doesn't like to wait. But I wanted a meal that didn't come with a toy. We waited 15 minutes to get seated. Then we waited another 15 minutes to get drinks and apis. During the third wait while our food was coming, Eric got very bored, tired and annoyed. I gave him my phone so he could FaceTime his cousin and sister to show off his spinach and artichoke dip api. That consumed 3 minutes. Eric informed me I had no good games on my phone. Finally we started playing tic tac toe. Montanas supplied crayons and a brown kraft paper table cloth. They seemed to replace the paper with every patron. Our waitress, Valerie, even wrote her name in crayon on the brown kraft paper. But back to tic tac toe. Eric beat me. More than once. Hes nine. I really had to pay attention to force the game to a draw or squeak out an occasional win. I definitely wasn't letting Eric win. I knew both my kids would eventually be smarter than me, but I didn't think it would be so soon.

Old film and video often surprises me as well. Have you ever watched old news footage? I love looking at the crowd shots. The average man and woman on the street 40 or 50 years ago was so skinny! Now, whenever a news event is on the TV, look at the crowd shots. Several people in the crowd will be overweight, if not obese. Obesity is a complicated thing. It involves how we eat, how much we move, whether we sit at work, how long we spend in a car and many other factors. One thing that can get over looked is what medications we are on. Some medications can cause weight gain. There are many different medications that can affect weight, but we are going to look at three classes.

Medications for diabetes. Not all diabetes medications cause weight gain. In fact some of the newer ones like liraglutide or victoza and forxega or dapagliflozin might actually cause weight loss. But the older diabetes agents, especially insulin, do cause weight gain. Depending on where I read, I found insulin will cause about a 15 lb weight gain over 3 years. Most of the weight gain usually happens in the first 3 months of use. Insulin is an anabolic hormone. That means it signals the body to grow. So muscle and especially fat cells are signaled to grow in the presence of insulin. Insulin may also stimulate the patient to consume more calories and may cause less sugar to spill out into the urine. The common diabetes pill, glyburide will also cause about a 6 lbs weight gain over the first 30 days someone is one it. It can be tricky to treat someone with diabetes without causing weight gain. If they are type 1 diabetic, they need insulin or they will die. So we don't have any alternative. For type 2 diabetics, we can try the new medications that are less likely to cause weight gain. However, the newer medications are more expensive and less likely to be covered by insurance or pharmacare.

Medications for depression. Paroxetine or paxil seems to be the worst medication for weight gain of the common antidepressants. The quotes I found said on average a patient would gain 6 lbs after 12 weeks on paroxetine. One in four patients on paroxetine may gain more than 7% of their starting body weight. It is unclear exactly why paroxetine causes weight gain. Paroxetine may increase cravings for carbohydrates. Paroxetine may cause increased appetite. There are other antidepressants that can be used instead of paroxetine. Wellbutrin or buproprion is an antidepressant that works on different brain chemicals than paroxetine. It is considered weight neutral. Some people even lose weight on buproprion. However, buproprion isn't perfect. We've had patients who found paroxetine treated their depression well but caused weight gain. When they got switched to buproprion, they found it didn't treat their depression as well. For those patients there were some tough decisions to make about whether to stay with the drug that worked well, or switch to the drug that caused less weight gain but didnt work as well.

Medications for seizures and mood stabilizers. Carbamazepine, gabapentin, valproic acid and lithium are very different medications, but they are all used in patients to prevent seizures and to stabilize the mood of people with mental health issues However, unfortunately they can also all cause weight gain. They may cause carbohydrate cravings, decrease blood sugar which causes hunger, and they might actually cause the body to burn fewer calories through the brain chemicals they affect. A newer medication called topiramate can actually cause weight loss. The problem is topiramate won't be appropriate to treat seizures or mood all patients and it is much more expensive than the older medications.

I already knew my daughter Emily was smarter than me. Shes been to couple provincial Science Fair competitions, and I never qualified for one. Shes competed 3 or 4 times in French speaking competitions. I think I read a French poem that I memorized in front of an audience once in elementary school. However, I definitely didnt research, write and then present the poem. But I wasnt as worried about Emily being smarter than me. Shes 13. I already knew I was dumber than a 7th Grader. But Eric beating me at tic tac toe worries me. Having a tomb stone that reads, Was he smarter than a 4th Grader? Not so much. wasnt the legacy I was hoping for.

As always if you have any questions or concerns about these products, ask your pharmacist.

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

 


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