Prescription medications currently prescribed for weight loss include:
• Generic name: Diethylpropion (Trade names: Tenuate, Tenuate dospan)
• Generic name: Mazindole (Trade name: Sanorex)
• Generic name: Orlistat (Trade name: Xenical)
• Generic name: Phendimetrazine (Trade names: Bontril, Plegine, Prelu-2, X-Troxine)
• Generic name: Phentermine (Trade name: Adipex-P, Fastin, Ionamin, Oby-trim)
• Generic name: Sibutramine (Trade name: Meridia)
Some antidepressant medications have been studied for use as possible appetite depressants, because they frequently depress appetite in the early weeks and months of use. Research indicates, however, that while individuals may lose weight initially during antidepressant treatment, a tendency to lose only modest amounts of weight arises after six months. Furthermore, most patients who lose weight early in antidepressant medication treatment tend to regain the weight while still using the medication.
Amphetamines and similar medications were frequently prescribed in the United States, during the 1960s and 70s, as appetite suppressants. However, because of their addictive potential, they are not prescribed today for weight control, except by a remainder of "diet doctors" who defy political correctness and continue to distribute them.
single drug treatment. The medications listed above are currently used to treat obesity. In general, these medications are modestly effective, especially when used in conjunction with a healthy diet and moderate exercise. Average weight losses between five and 22 pounds can be expected beyond those seen with non-drug obesity treatments, when only a low-calorie diet and exercise regimen are followed. There is considerable individual variation in response to weight-loss medications; some people experience more weight loss than others.
combined drug treatment. Combined drug treatment using fenfluramine and phentermine ("fen/phen") is no longer available due to the withdrawal of fenfluramine from the market. There is little information about the safety or effectiveness of other prescription drug combinations for weight loss. Until further research is conducted on safety or effectiveness, using combinations of medications for weight loss is not advised unless a patient is participating in a research study.
potential benefits of appetite suppressant treatment. Short-term use of appetite suppressant medications has been shown to modestly reduce health risks for obese individuals. Studies have found that these medications can lower blood pressure, blood cholesterol, blood fats (triglycerides), and decrease insulin resistance (the body's ability to utilize blood sugar). Long-term studies need to be conducted to determine if weight loss assisted by appetite suppressant medications can improve health long-term.
potential risks of appetite suppressant treatment. All prescription medications used to treat obesity, with the exception of orlistat, are controlled substances. This means that doctors need to follow rigid guidelines when prescribing them. Although abuse and dependence are uncommon with non-amphetamine appetite suppressant medications, doctors need to exercise caution when prescribing them, especially for patients with a history of alcohol or drug abuse.
development of tolerance. Studies of appetite suppressant medications indicate that an individual's weight tends to level off after four to six months of treatment. While some patients and doctors may be concerned that this indicates growing tolerance to the medications, the leveling off may indicate that the medication has reached its limit of effectiveness. Current research is not clear regarding whether weight gained with continued medication is due to drug tolerance, or to reduced effectiveness of the medication over time.
side effects. Because obesity is a condition affecting millions of Americans, many of whom are basically healthy, the side effects of using powerful medications such as appetite suppressants are of great concern. Most side effects of these medications are mild and diminish as treatment continues. Rarely, serious and even fatal outcomes have been reported. The FDA-approved appetite suppressant medications that affect serotonin (fenflu-ramine and dexfenfluramine) have been withdrawn from the market. Medications that affect catecholamine levels (such as phentermine, dietylpropion, and mazindol) may cause symptoms of sleeplessness, nervousness, and euphoria.
Primary pulmonary hypertension (PPH) is a rare but potentially fatal disease that affects the blood vessels in the lungs and causes death within four years in 45% of its victims. Patients who use the appetite suppressant medications that are prescribed for a use of three months are at increased risk of developing this condition if used longer. Estimates are that between 1 in 22,000 and 1 in 44,000 individuals will develop the disorder each year. While the risk of developing PPH is very small, doctors and patients should be aware of this potentially deadly complication when they consider the risks and benefits of using appetite suppressant medications for long-term treatment of obesity. Patients taking appetite suppressants should contact their doctors if they experience shortness of breath, chest pain, faintness, or swelling in the lower legs and ankles. The vast majority of cases of PPH related to appetite suppressant use have occurred in patients taking fenfluarmine or dexfenfluramine, either alone or in combination with each other or other drugs, such as phentermine. There have been only a few cases of PPH reported among patients taking phentermine alone, although the possibility that phentermine alone may be associated with 2 PPH cannot be ruled out at this time.
Animal research has suggested that appetite suppres-| sant medications affecting the neurotransmitter serotonin, such as fenfluramine and dexfenfluramine, can damage the central nervous system. These findings have not been reported in humans. Some patients have reported depression or memory loss when using appetite suppressant medications alone or in combination, but it is not known if these problems are actually caused by the medications or by other factors.
In addition to the numerous prescription medications for weight loss, a few over-the-counter agents are marketed for weight loss. The most common, phenyl-propanalomine, is an appetite suppressant that is distantly related to the amphetamines. Like the amphetamines, this drug has the side effect of increased blood pressure and heart rate, and thus should not be used by anyone with hypertension or heart disease. Other over-the-counter medications contain fiber or bulking agents, and presumably work by increasing the sensation of fullness. Some preparations contain the anesthetic benzocaine. This agent numbs the mouth and may make eating less appealing temporarily. No evidence exists that any of these medications is effective in producing significant weight loss.
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Barbara S. Sternberg, Ph.D.
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