Drugs that can cause Metabolic Syndrome Part 1

Posted on by Jesse Santiano, M.D.

Metabolic syndrome is a constellation of five medical conditions: hypertension, high blood sugar, obesity, low HDL, and triglycerides.

All five work together to cause common medical conditions that lead to expensive medical bills and early death. Heart attacks, strokes, diabetes, and hypertensive crises, and many others are best avoided.

A sedentary lifestyle and high caloric intake are well-known causes of the five conditions leading to metabolic syndrome.

However, some commonly used medications can also lead to the formation of metabolic syndrome. In general, these drugs change how the body processes fats and sugar the body and causes weight gain.

Anti-Hypertensive medications

Thiazide Water Pills

Diuretics induce a person to make more urine. That is why they are commonly called water pills.  The increase in urine formation contributes to the decrease in blood pressure.

Examples of thiazide diuretics are hydrochlorothiazide or HCTZ and metolazone.

In a meta-analysis, thiazides can increase total cholesterol, LDL, or “bad cholesterol” and triglycerides, especially at high doses.

Thiazides also add to insulin resistance and difficulty in controlling the blood sugar in diabetic patients.

Beta-Blockers

Beta-blockers lower blood pressure by slowing the heart rate and relaxing the arteries. They block the binding of noradrenaline and adrenaline to the α, β1, and β2 receptors of the heart and the blood vessels.

β-1 selective blockers like atenolol, betaxolol, bisoprolol, esmolol, acebutolol, metoprolol, and nebivolol have little effect on cholesterol and LDL cholesterol. But they can lower the HDL and increase triglycerides. Both are components of metabolic syndrome.

In the ARIC or Atherosclerosis Risk in Communities Study, the use of β blockers increases the risk of developing insulin resistance and a 28% increase in the risk of developing diabetes.

Beta-blockers can also cause weight gain and decrease blood circulation, particularly in the arms and legs.

In contrast, labetalol, a beta-blocker that affects both α and β sites, does not change the lipid levels.

Carvedilol, an α, β1, and β2 blocker does better by having favorable effects on the lipid profile and is associated with an 8% increase in HDL and a 20% reduction of triglycerides.

Bear in mind that despite the potential to cause diabetes and alter lipids, studies have shown that beta-blockers lower the risk of death in hypertension, heart attacks, and strokes.

Niacin

Niacin is used to increase HDL and lower triglycerides. It can also lower LDL to a certain extent.

However, other research has shown that it can raise blood sugar levels in people at risk for diabetes. In diabetics, it prevents adequate blood sugar control.

Another trial concludes that diabetic patients can take niacin, provided the blood glucose levels are carefully watched.

Thiazolidinediones

Thiazolidinediones or TZDs are used for diabetes treatment. They can also affect the way the body handles fat and cholesterol.

Rosiglitazone (Avandia) was shown to increase total cholesterol and LDL. On the other hand, pioglitazone (Actos) can lower triglycerides and not affect total cholesterol or LDL.

Both rosiglitazone and pioglitazone can cause weight gain.

Oral Contraceptives (OCS)

Birth control pills or oral contraceptives contain estrogen and progestin. High-dose OCS can result in high blood sugar. As opposed, low-dose OCS causes a minimal change in blood sugars.

Estrogen increases triglycerides and HDL but lowers LDL. Meanwhile, progestins can raise LDL and lower HDL.

Women who take OCS should ask their doctors whether they need their lipid profiles tested.

Protease Inhibitors

Protease inhibitors are used to treat Acquired Immunodeficiency Syndrome or AIDS and Hepatitis C. Examples of which are lopinavir and ritonavir.

People who use protease inhibitors can develop acquired lipodystrophy. Lipodystrophy is wasting fat under the skin in the face, arms, and legs with an accumulation of fat in the abdomen, neck, and upper back.

Protease inhibitors can increase total cholesterol by 40%, and triglyceride levels may increase by 200 to 300 mg/dl!

Take-Away Message

This article is not written to convince anyone to stop taking their medications. Many carefully made studies have shown that these medicines work. Unfortunately, there is no “magic pill” that can be prescribed that has no side effects.

In the end, a physically active lifestyle with healthy and moderate meals is the best way to avoid metabolic syndrome.

In Part 2, drugs used for psychiatry, including antidepressants and transplant medications, will be discussed.

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Reference: Wofford MR, King DS, Harrell TK. Drug-induced metabolic syndrome. J Clin Hypertens (Greenwich). 2006;8(2):114-119. doi:10.1111/j.1524-6175.2006.04751.x

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