For medical professionals only
Eating too much is not just about gaining weight
In addition to those friends who like to eat haise but don’t like to exercise, there are some people who clearly pay attention to their diet and exercise, but they still gain weight! Why is this?
This so-called “drinking cold water makes flesh grow” may be caused by drugs!
01 Insulin
Insulin can cause obesity, and the mechanisms that lead to weight gain may include the following:
Insulin therapy allows for better control of blood sugar, which reduces the amount of glucose excreted in the urine, so that fewer calories are lost in the urine.
Insulin itself has the effect of directly promoting lipid synthesis in adipose tissue. The insulin secreted by pancreatic islets first passes through the liver, so most of the insulin has been cleared by the liver before reaching the tissue.
Exogenous insulin first reaches peripheral tissues, such as fat, muscle, etc., and then enters the liver.
Insulin therapy therefore increases fat synthesis due to excessive exogenous insulin concentrations.
A common adverse effect of insulin therapy is hypoglycemia, which can cause patients to eat defensively, eat more calories, and gain weight.
There is, however, one exception to insulin preparations, with studies showing that insulin detemir is effective in controlling blood sugar while significantly reducing the risk of hypoglycemia, including nocturnal hypoglycemia , and presents a unique advantage of less weight gain [8].
Insulin detemir’s weight advantage is seen across different body mass index (BMI), glycated hemoglobin (HbA1c), or age groups, but is more pronounced in certain groups, such as high Baseline BMI, patients with large improvement in HbA1c, etc. [9].
02Oral hypoglycemic agents
Some thiazolidinediones (TZDs) hypoglycemic drugs can affect the endocrine system and improve the metabolic level in the body, so they all have adverse reactions of weight gain [6].
However, some studies have found inconsistent results on the effect of TZDs on body weight. Results of the ADOPT study showed that TZDs increased body weight [7]. Similar findings were also validated in the DREAM trial, while the CONFIDENCE study in China showed that pioglitazone had no effect on body weight and reduced waist circumference.
In addition, sulfonylureas and glinides drugs commonly used in clinical practice are insulin secretagogues and also have the effect of increasing body weight.
03Glucocorticoids
Mainly cortisol, long-term high doses can cause hypercortisolism, “full moon face, buffalo back”, and central obesity.
04Progestins
1
Megestrol
Megestrol Acetate (Niagestin) is a progestin drug, mainly used to treat metastatic breast cancer and endometrial cancer that depend on hormone growth.
Increased weight and appetite were the most prominent and typical adverse reactions, with an incidence of 81%-88% of weight gain and 53% of increased appetite [4].
Clinical studies have shown that weight gain is primarily an increase in adipose tissue rather than muscle tissue, and is not necessarily related to fluid accumulation (that is, pure fat).
But it is precisely because of this special effect that megestrol is often used clinically to treat anorexia and cachexia in patients with advanced cancer, which can significantly improve the prognosis of patients with advanced cancer. quality of life [4].
2
Levonorgestrel
The main form of the drug in clinical application is the levonorgestrel-releasing intrauterine system (LNG-IUS). Some studies have pointed out that patients using this preparation have individual differences in weight changes. Very large, LNG-IUS does not necessarily lead to weight gain [5].
05Antidepressants
The International Consensus Statement: Monitoring of Antidepressant-Related Adverse Events in the Treatment of Adult Depression, published by the World Federation of Biological Psychiatric Societies (WFSBP), mentions that antidepressant drugs (SSRIs) When treating major depressive disorder (MDD), it can lead to weight gain or obesity.
And obesity can also lead to a reduced response to antidepressants,Women who take it longer are more likely to gain weight or become obese.
Tricyclic antidepressants (TCAs) are associated with the highest risk of weight gain or obesity of all antidepressants [3]. Monoamine oxidase inhibitors (MAOIs, such as phenelzine, phenylcypromine, isocarboxazid, moclobemide, and toloxadone) also cause weight gain, with an increased effect similar to or greater than that of tricyclic antidepressants. Weak [1].
06Other Drugs
Other drugs include the atypical antipsychotics clozapine, olanzapine, quetiapine, risperidone;
Sodium valproate and lamotrigine in antiepileptic drugs;
H1 receptor antagonists include astemizole, mizolastine, terfenadine and ketotifen.
Obses are already so hard
Don’t expose some things
Doctors should explain the medication when prescribing the above-mentioned related drugs, and ask the patient whether there is a weight loss plan in the near future. If the patient needs to control the weight, the appropriate treatment plan should be selected according to the patient’s condition, and the drugs that cause obesity should be avoided as much as possible.
If patients have started taking these drugs and have adverse reactions of weight gain, they should adjust their diet and living habits in a timely manner, and pay attention to nutrition and behavioral therapy. Limit sugar and fat diets, exercise more, and monitor weight changes.
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References:
[1] Zhou Jianying, Gao Xiaoya, Ma Xianghua. Research progress of drug-related obesity[J]. International Journal of Endocrinology and Metabolism, 2006, 26 ( 01 ): 32-34.
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[2] Zhong Yingqiang, Huang Huarong, Zhang Shineng. Adverse reactions of venlafaxine in the treatment of functional gastrointestinal diseases with depression or anxiety[J]. Chinese New Drugs and Clinical Practice Journal, 2002(11):693-695.
[3]Dodd S , Mitchell P B , Bauer M , et al. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement[J]. World J Biol Psychiatry, 2017:1-19.
[4] Lu Yi, Wu Hongbin. Adverse reactions of megestrol[J]. Journal of Adverse Drug Reactions, 2003 (01): 26-28.
[5] Lang Jinghe, Leng Jinhua, Deng Shan, et al. Chinese expert consensus on clinical application of levonorgestrel intrauterine sustained-release system [J]. Chinese Journal of Obstetrics and Gynecology, 2019, 54(12):815-825.
[6] Chinese Medical Association, Clinical Pharmacy Branch of Chinese Medical Association, Journal of Chinese Medical Association, et al. Guidelines for rational drug use at the grassroots level for type 2 diabetes [J] . Chinese Journal of General Practitioners, 2021 , 20(6): 615-630.
[7] Zhao Yijing, Wang Kun, Liu Chao. Re-understanding of the clinical value and safety of thiazolidinediones [J] . International Journal of Endocrinology and Metabolism, 2019,39 (4): 236-240.
[8] Pan Changyu. Long-acting insulin detemir once a day: Significantly reduces weight gain and hypoglycemia[J]. International Journal of Endocrinology and Metabolism, 2008, 28 (03): 155 -157.
[9] Kuang Hongyu. Insulin detemir and individualized treatment of diabetes [J]. Chinese Journal of Diabetes, 2014, 6 (1): 56-58.
This article was first published: Clinical Pharmacy Channel in the Medical Community
The author of this article: Radish Bai Cai
Editor in charge: Wen Jiaxin
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