Pijl H, Meinders A E
Department of General Internal Medicine, Leiden University Hospital, The Netherlands.
Drug Saf. 1996 May;14(5):329-42. doi: 10.2165/00002018-199614050-00005.
A number of drugs are capable of changing bodyweight as an adverse effect of their therapeutic action. Bodyweight gain is more of a problem than bodyweight loss. As bodyweight gain during drug treatment for any kind of disease may be the reflection of improvement of the disease itself, we will try to separate these effects from those due to drug-induced alterations of the mechanisms regulating bodyweight. Bodyweight gain may jeopardise patient compliance to the prescribed regimen and it may pose health risks. The body mass index (BMI) is determined by dividing bodyweight in kilograms by height in metres squared. A BMI of > or = 27 kg/m2 warrants therapeutic action; nutritional counselling and programmed physical exercise can be used as a basis. In general, if basic therapeutic measures are unsuccessful at controlling bodyweight gain then a change of drug might help. Finally, an anoretic drug may serve to support dietary measures. However, safety and efficacy has been demonstrated for only a few anorectic drugs when used as an adjunct to caloric restriction in the treatment of drug-induced obesity. Bodyweight is determined by complex mechanisms regulating energy balance. A number of neurotransmitter systems acting in several hypothalamic nuclei are pivotal to the regulation of body fat stores. Most drugs that are capable of changing bodyweight interfere with these neurotransmitter systems. The increment is dependent on the type and dose of the drug concerned. Some antidepressant drugs induce bodyweight gain, which may amount to 20 kg over several months of treatment. Monoamine oxidase inhibitors appear to cause less bodyweight change than tricyclic antidepressants. Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors cause bodyweight loss instead of bodyweight gain. Lithium may cause large increases in bodyweight. Generally speaking, the bodyweight change induced by antipsychotics is more often of clinical significance than the bodyweight change associated with the use of antidepressants. Again, the changes of bodyweight are dependent upon the type and dose of the antipsychotic drug involved. Although almost all antipsychotics induce bodyweight gain, molindone and loxapine appear to induce bodyweight loss. Anticonvulsants, especially valproic acid (sodium valproate) and carbamazepine, induce bodyweight gain in a considerable percentage of patients. Treatment with corticosteroids is associated with dose-dependent bodyweight gain in many patients. Corticosteroid-induced obesity aggravates other corticosteroid-associated health risks. Insulin therapy in diabetic patients usually increases bodyweight. Finally, sulphonurea derivatives, antineoplastic agents used for the treatment of breast cancer and several drugs used in migraine prophylaxis may cause bodyweight gain as well.
许多药物在发挥治疗作用时会产生改变体重的副作用。体重增加比体重减轻更是一个问题。由于在治疗任何疾病时药物治疗期间的体重增加可能反映疾病本身的改善，我们将试图把这些影响与药物引起的体重调节机制改变所导致的影响区分开来。体重增加可能会危及患者对规定治疗方案的依从性，并且可能带来健康风险。体重指数（BMI）通过将体重（千克）除以身高（米）的平方来确定。BMI大于或等于27kg/m²就需要采取治疗措施；营养咨询和有计划的体育锻炼可以作为基础。一般来说，如果基本治疗措施无法成功控制体重增加，那么更换药物可能会有帮助。最后，一种食欲抑制剂药物可能有助于支持饮食措施。然而，在作为热量限制的辅助手段用于治疗药物性肥胖时，只有少数食欲抑制剂药物的安全性和有效性得到了证实。体重由调节能量平衡的复杂机制决定。一些作用于多个下丘脑核团的神经递质系统对身体脂肪储存的调节至关重要。大多数能够改变体重的药物会干扰这些神经递质系统。体重增加量取决于相关药物的类型和剂量。一些抗抑郁药物会导致体重增加，在几个月的治疗过程中体重增加量可能达到20千克。单胺氧化酶抑制剂似乎比三环类抗抑郁药引起的体重变化更小。选择性5-羟色胺再摄取抑制剂会导致体重减轻而不是体重增加。锂可能会导致体重大幅增加。一般来说，抗精神病药物引起的体重变化比使用抗抑郁药物相关的体重变化在临床上更常具有重要意义。同样，体重变化取决于所涉及的抗精神病药物的类型和剂量。尽管几乎所有抗精神病药物都会导致体重增加，但吗茚酮和洛沙平似乎会导致体重减轻。抗惊厥药，尤其是丙戊酸（丙戊酸钠）和卡马西平，在相当比例的患者中会导致体重增加。在许多患者中，使用皮质类固醇治疗与剂量依赖性体重增加有关。皮质类固醇引起的肥胖会加重其他与皮质类固醇相关的健康风险。糖尿病患者的胰岛素治疗通常会增加体重。最后，磺脲类衍生物、用于治疗乳腺癌的抗肿瘤药物以及几种用于预防偏头痛的药物也可能导致体重增加。
