For medical professionals only
Gaining weight isn't just about eating too much
Three pounds of weight every festive season
Friends, this Spring Festival holiday
Is not crazy at home "dazzling" sugar oranges
Taste a variety of New Year goods
Do you find yourself fat again when you stand on the scale?
Except for those who like to eat haysers and do not like sports. There are some people who obviously pay attention to their diet and exercise, and as a result, they still gain weight! Why?
This so-called "drinking cold water is long meat", it may be caused by drugs!
01 Insulin
Insulin can cause obesity, and its mechanism for weight gain may be as follows:
Insulin therapy allows blood sugar to be better controlled, thereby reducing the excretion of glucose in the urine, which reduces the amount of heat lost from the urine;
Insulin itself has the effect of directly promoting lipid synthesis in adipose tissue, and the insulin secreted by the 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., before entering the liver.
Therefore, when insulin is treated, fat synthesis is increased due to excessive concentration of exogenous insulin.
A common adverse effect of insulin therapy is hypoglycemia, which causes patients to eat defensively, which leads to more calorie intake and weight gain.
However, there is one exception to insulin preparations, where studies have shown that while insulin detemir is effective in controlling blood sugar, the risk of hypoglycemia (including nocturnal hypoglycemia) is significantly reduced and presents a unique advantage of less weight gain [8].
The weight advantage of insulin detemir is reflected in different body mass index (BMI), glycosylated hemoglobin (HbA1c), or in age groups, but is more prominent in some groups, such as those with high baseline BMI and patients with large improvements in HbA1c [9].
02 Oral hypoglycemic drugs
Rosiglitazone, pioglitazone. Both classes of drugs are thiazolidinediones (TZDs) hypoglycemic agents, both of which affect the endocrine system and improve metabolic levels in the body, so both have adverse effects of weight gain [6].
However, some studies have found that the results of the effect of TZDs on weight are inconsistent. The results of the ADOPT study show that TZDs increase body weight [7]. Similar findings were validated in the DREAM trial, while the RESULTS of the CONFIDENCE study in China showed that pioglitazone had no effect on body weight and reduced waist circumference.
In addition, the commonly used clinical sulfonylureas and glinide drugs are insulin secretagogues, which also have the effect of increasing weight.
03 Glucocorticoids
Mainly cortisol, long-term high-dose use can cause hypercortisolism, the appearance of "full moon face, buffalo back", centripetal obesity.
04 Progestogen drugs
1
Megesterone
Megestrol Acetate (Niagestin) is a progestin drug that is mainly used to treat metastatic breast cancer and endometrial cancer that rely on hormone growth.
Weight and appetite gain are the most prominent and typical adverse effects, with an incidence of weight gain in 81 to 88 percent and an increase in appetite at a rate of 53 percent [4].
Clinical studies have shown that weight gain is mainly an increase in adipose tissue rather than muscle tissue, which is not necessarily related to the accumulation of fluid (that is, the length is pure fat).
However, it is precisely because of this special effect that megesterone is often used clinically to treat anorexia and cachexia in patients with advanced cancer, which can significantly improve the quality of life of patients with advanced cancer [4].
2
Levonorgestrel
The main form of the drug in clinical application is the levonorgestrel intrauterine sustained-release system (LNG-IUS), and it has been noted that in patients using this preparation, the individual weight changes vary greatly, and LNG-IUS does not necessarily lead to weight gain [5].
05 Antidepressants
The International Consensus Statement: Monitoring of Antidepressant-Related Adverse Events in the Treatment of Depression in Adults, published by the World Federation of Biopsychiatric Societies (WFSBP), mentions that antidepressant treatment drugs (SSRIs) can lead to weight gain or obesity in patients when treated with major depressive disorder (MDD).
And obesity can also lead to a reduced response to antidepressants in patients, and women who take it for a long time are more likely to experience weight gain or obesity.
Of all antidepressants, tricyclic antidepressants (TCAs) have the highest risk of weight gain or obesity [3]. Monoamine oxidase inhibitors (MAOIs, such as phenylacetine, phenylcyclopropylamine, isocarbohydrazine, moclobemide, and toloxazone) also cause weight gain, with an increase in effect similar to or weaker than that of tricyclic antidepressants[1].
06 Other drugs
Other drugs include the atypical antipsychotics clozapine, olanzapine, quetiapine, risperidone;
Sodium valproate and lamotrigine in antiepileptic drugs;
Astemizole, mizolastine, terfenadine and ketotifen in H1 receptor antagonists.
Fat life has been so hard
Some things should not be debunked
Doctors should explain the medication when prescribing the above related drugs and ask patients whether they have 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 situation, and drugs that cause obesity should be avoided as much as possible.
If the patient has begun to take these drugs and has developed adverse effects of weight gain, diet and living habits should be adjusted in time, focusing on nutrition and behavioral therapy. Limit sugar and fat diets, increase exercise, and monitor weight changes.
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Resources:
Zhou Jianying, Gao Xiaoya, Ma Xianghua. Research advances in drug-associated obesity[J] . International Journal of Endocrinology and Metabolism,2006,26( 01 ): 32-34.
Zhong Yingqiang, Huang Huarong, Zhang Shineng. Adverse reactions in the treatment of functional gastrointestinal disorders with depression or anxiety with venlafaxine[J]. Chinese Journal of New Drugs and Clinical Practices, 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.
Lu Yi, Wu Hongbin. Adverse reactions of megesterone[J]. Journal of Adverse Drug Reactions, 2003(01):26-28.
Lang J H, Leng J H, Deng X, et al. Chinese expert consensus on the clinical application of levonorgestrel intrauterine sustained release system[J]. Chin J Obstetrics & Gynecology, 2019, 54(12):815-825.
Chinese Medical Association, Chinese Medical Association Clinical Pharmacy Branch, Chinese Medical Association Journal, et al. Guidelines for rational use of primary medication for type 2 diabetes [J] . Chinese Journal of General Practitioners, 2021, 20(6): 615-630.
Zhao Yijing, Wang Kun, Liu Chao. Re-understanding of the clinical practical value and safety of thiazolidinediones[J] . International Journal of Endocrinology and Metabolism,2019,39(4): 236-240.
Pan Changyu. Long-acting insulin detemir once daily: significantly reduces weight gain and the incidence of hypoglycemia [J]. International Journal of Endocrinology and Metabolism,2008,28( 03 ): 155-157.
KUANG Hongyu. Insulin detemir and individualized therapy for diabetes mellitus [J] . Chinese Journal of Diabetes,2014,6 (1): 56-58.
Source: Clinical Pharmacy Channel of the Medical Community
Author: Radish White Cai
Editor-in-charge: Wan Shunshun
Proofreader: Zang Hengjia
Plate making: Xue Jiao