9
Concomitant Pharmacotherapy
HIV Medications
May increase body weight, primarily abdominal and visceral fat
• Some highly active antiretroviral therapies (HAART) with protease
inhibitors (not indicated for patients with HIV-associated lipodystrophy)
Chemotherapies and Anti-Inflammatory Agents
May increase body weight:
• Tamoxifen
• Cyclophosphamide
• Methotrexate
• 5-fluorouracil
• Aromatase inhibitors
• Tumor necrosis factor alpha
inhibitors
• Corticosteroids
May decrease body weight:
• Apremilast
Organ Transplant Medications
Corticosteroids (e.g., prednisone)
• Corticosteroids may increase body weight (as well as increase blood
sugar, blood pressure, and blood lipids).
• Rapid discontinuation of prednisone (prior to discharge after
hospitalization for transplant) may have improved survival
without much change in body weight compared to patients with
maintenance prednisone.
Calcineurin inhibitors (cyclosporin, tacrolimus)
• Calcineurin inhibitors may increase body weight as well as
components of the metabolic syndrome.
Mammalian target of rapamycin (mTOR) inhibitors (sirolimus,
everolimus, temsirolimus)
• mTOR inhibitors may increase body weight, as well as contribute to
the components of the metabolic syndrome.
Obesity and Organ Transplantations
• Obesity is the most common promoter of metabolic disorders
leading to organ failure. Post-transplant medications may
additionally contribute to metabolic disorders.
• Obesity increases the diff iculty, time, and rate of complications
of surgical procedures. Patients with obesity undergoing organ
transplant may benef it f rom pre-transplant weight management
interventions with continued weight management interventions
post-transplant.
• Increased caloric intake after organ transplant is often related to post
transplant improvement in health, symptoms, and quality of life.
Steroid avoidance alone does not mitigate increase in body weight
after organ transplant.
(cont'd)
