Weight gain is a possible side effect with medications. Which medications cause enough weight gain to warrant detailed counselling and possible intervention?
Drugs that cause substantial weight gain include some members of the following classes: antipsychotics, mood stabilizers, antiepileptics, antidepressants, oral contraceptives, antihistamines, and corticosteroids.
Olanzapine and Clozapine are major causes of weight gain. About 3/4ths of patients using olanzapine will gain ~ 4.5 kg during the first 10 weeks of therapy. Chronic use may be associated with even more weight gain. If either olanzapine or clozapine cause weight gain exceeding 5% of baseline weight, switching to an alternative drug or the addition of metformin may be considered. The weight gain associated with clozapine and olanzapine places patients at increased risk of diabetes and heart disease.
20% of patients using lithium gain greater than 9 kg in weight.
About half of those who take valproic acid will experience a 10% weight gain. If weight gain is an issue, swiching to lamotrigine or carbamazepam are valid options.
The antidepressants MAO-Inhibitors, tricyclic antidepressants and mirtazapine are associated with substantial weight gain. SSRIs are okay in the short run. Taken for longer than 6 months, SSRIs are associated with weight gain. If weight gain is an issue with these antidepressants, switching to venlafaxine, duloxetine or bupropion may be good options.
Oral contraceptives may cause a transient weight gain due to increased fluid retention. The weight gained initially is usually lost with time. Depo-Provera is associated with weight gain of 5kg over 5 years.
Antihistamines and corticosteroids will cause some weight gain as well. Thus, inhaled or intranasal corticosteroids are preferred.
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