Does propranolol cause weight gain?

In this article:

• Does propranolol cause weight gain?
• Why does propranolol cause weight gain?
• Other beta blockers and weight gain
• How to avoid propranolol weight gain 

In this article

• Does propranolol cause weight gain?
• Why does propranolol cause weight gain?
• Other beta blockers and weight gain
• How to avoid propranolol weight gain 

Propranolol is a beta blocker drug that has been around since the 1950s and still sees use for high blood pressure, atrial fibrillation, essential tremor, and migraine prevention, among other health conditions. Propranolol is also known by the brand name of its extended-release version, Inderal LA. Seven decades of use have resulted in plenty of accumulated knowledge about propranolol’s benefits and insight into its side effects. One such unfortunate side effect is weight gain. Multiple reports have arisen connecting propranolol therapy to weight gain, so if you are thinking about starting propranolol tablets, you should look further into this association.

Does propranolol cause weight gain?

Weight gain is not listed among the side effects of propranolol on its drug label. Instead, effects like allergic reaction, shortness of breath, slow heartbeat, lightheadedness, fatigue, and low blood pressure are listed. This likely means weight gain was not detected in the initial drug studies many years ago. 

However, subsequent research suggests there is an association. A 40-month study involving over three thousand patients randomized participants to either take propranolol or placebo, an inactive tablet. After a year, those on propranolol gained about two and a half pounds more than those on placebo, and that weight differential remained fairly stable and persistent through the end of the three-year study. 

A review article citing case reports of individual patients indicated that weight gain on propranolol could be upwards of twenty pounds. That does not mean everyone will gain that much or gain any weight. A six-month study found that 8% of patients with migraine headaches taking propranolol gained weight. Collectively, the research indicates a modest potential to put on some pounds, and if so, the amount is usually not profound, although more significant weight gain can occur.

Why does propranolol cause weight gain?

Gaining weight results from an imbalance between calories consumed and calories expended, or less commonly, from fluid accumulation. Although propranolol and another beta blocker like it can trigger congestive heart failure decompensation in certain situations, they generally do not cause fluid retention otherwise. 

Weight gain with propranolol is more likely to result from reduced calories expended. Studies indicate that our metabolism burns fewer calories and promotes higher blood sugar levels while on beta blockers. In addition, fatigue is a common side effect, and when a tired individual moves less, fewer calories are utilized, resulting in weight gain.

Other beta blockers and weight gain

Propranolol is not alone among beta blockers in its effects on weight. Tenormin (atenolol) has also been linked to a similar extent of weight gain, and this is most likely a class effect shared amongst other beta blockers, like Toprol XL (extended-release metoprolol). 

A non-randomized study comparing different beta blockers used among overweight and obese patients attempting to lose weight found that third-generation beta blockers, like Coreg (carvedilol) and Bystolic (nebivolol), seemed to be more favorable for weight loss than other members of the class. This may be due to their additional influence on blood vessel dilation.

Concerns about weight are one reason why beta blockers are not first-line treatment options for hypertension. Diuretics and angiotensin-converting enzyme inhibitors (ACE inhibitors) are drug classes that effectively lower blood pressure while not creating a tendency for weight gain. Calcium channel blockers, another alternative antihypertensive, may lead to fluid retention but not weight gain otherwise.

How to avoid propranolol weight gain 

For each of its indications from the U.S. Food and Drug Administration (FDA), such as treatment of angina or chest pain from heart disease, heart rate control when the heart rhythm is disturbed, and risk reduction after a heart attack, as well as its off-label uses for performance anxiety and overactive thyroid, propranolol is not the only choice. Alternatives are available, but in some cases, propranolol may be the best option for efficacy at an affordable price. If so, get the medical advice of your healthcare provider to see if measures like the following can be taken to prevent weight gain.

• Reduce portion sizes. By cutting back the size of meals, calorie intake can be reduced to offset the amount of calories expended.
• Adjust carbohydrate intake. Many of the calories in our diet come from carbohydrates. Trimming back on carbohydrates, like sugars, potatoes, breads, and pasta, can be a useful way to lower calorie consumption. Whole grain breads and pastas are a better bet within this food category.
• Use a meal replacement. A limited-calorie protein bar or shake instead of one of the day’s meals can be a nutritious and less-calorie-laden substitute.
• Ratchet up the exercise. Counter the reduction in baseline calories expended due to propranolol by burning some extra during workouts. If your medical team approves, you could increase the duration or intensity of the workouts.
• Increase your daily steps. Bumping up the daily step count can be a good way to burn a few more calories and possibly avoid weight gain with propranolol.
• Ask about alternatives to propranolol. The healthcare professionals on your treatment team may be able to find an equally efficacious medication to replace propranolol. If price is a hindrance, use a SingleCare discount card to help out.
• Monitor your weight. Stepping on the scale regularly can help determine if weight gain is even an issue for you with propranolol and help to provide feedback on whether lifestyle measures are helping.