Can atorvastatin, Symbicort (budesonide/formoterol), buprenorphine, bupropion, cyclobenzaprine, escitalopram, or propranolol (propanolol) cause unintentional weight loss?

Medications That Can Cause Unintentional Weight Loss

Among the medications listed, bupropion is the only one consistently associated with weight loss, while the others (atorvastatin, Symbicort, buprenorphine, cyclobenzaprine, escitalopram, and propranolol) are generally not known to cause significant unintentional weight loss. 1

Medications Associated with Weight Loss

Bupropion

• Bupropion is the only antidepressant consistently shown to promote weight loss 1
• Clinical trials have demonstrated that bupropion decreases body weight by suppressing appetite and reducing food cravings 1
• In weight loss studies, bupropion SR at doses of 300-400 mg/day was associated with 7.2-10.1% weight loss over 24 weeks compared to 5% with placebo 2
• FDA-approved drug label for bupropion notes that 14-19% of patients lost >5 lbs while taking bupropion SR 300-400 mg/day, compared to 6% with placebo 3
• In SAD (Seasonal Affective Disorder) trials, 23% of patients taking bupropion extended-release lost ≥5 lbs compared to 11% on placebo 3

Medications Not Typically Associated with Weight Loss

Escitalopram

• Unlike bupropion, escitalopram (an SSRI) is generally considered weight-neutral with long-term use 1
• While some SSRIs like fluoxetine and sertraline may cause initial short-term weight loss, they typically become weight-neutral with continued use 1
• The FDA label for escitalopram lists "decreased appetite" as an adverse reaction occurring in 3% of patients (vs 1% with placebo), but does not list significant weight loss as a common side effect 4

Propranolol

• Beta-blockers like propranolol are more commonly associated with weight gain rather than weight loss 1
• Propranolol is not mentioned in the guidelines as a medication that causes weight loss 1

Atorvastatin

• Statins like atorvastatin are not mentioned in the obesity management guidelines as medications associated with weight loss 1
• The evidence does not suggest that atorvastatin causes unintentional weight loss

Symbicort (budesonide/formoterol)

• Inhaled corticosteroids and long-acting beta-agonists like those in Symbicort are not listed in guidelines as medications that cause weight loss 1
• Unlike oral glucocorticoids which can cause weight gain, inhaled steroids have minimal systemic effects 1

Buprenorphine

• Opioid medications like buprenorphine are not mentioned in the guidelines as causing weight loss 1
• Opioids can sometimes cause nausea as a side effect, but significant weight loss is not a commonly reported adverse effect

Cyclobenzaprine

• Muscle relaxants like cyclobenzaprine are not mentioned in the guidelines as medications associated with weight loss 1

Clinical Implications

• When evaluating unintentional weight loss in patients taking multiple medications, bupropion is the most likely culprit among the listed medications 1, 2
• The weight loss effect of bupropion is dose-dependent, with higher doses (400 mg/day) producing greater weight loss than lower doses (300 mg/day) 2
• Bupropion's weight loss properties have been leveraged in the FDA-approved weight loss medication Contrave, which combines bupropion with naltrexone 1
• For patients concerned about weight loss while on bupropion, dose reduction may be considered if the weight loss is problematic 3

Monitoring Recommendations

• Monitor weight regularly in patients taking bupropion, especially those who are underweight or at risk for malnutrition 3
• If significant unintentional weight loss occurs in patients taking multiple medications including bupropion, consider bupropion as a potential cause 1, 2
• For patients taking escitalopram who experience weight loss, consider that this is less likely due to the medication and may warrant further investigation for other causes 1, 4