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Prescription Prescription MedicationsMedications
David L. Gee, PhD
Professor of Food Science and Nutrition
Central Washington University
Major Categories of Major Categories of Weight Loss DrugsWeight Loss Drugs
Appetite SuppressantsInhibitors of Nutrient Absorption(Metabolic Stimulants)
Appetite Suppressants:Appetite Suppressants:
Serotonergic DrugsSerotonergic Drugs
Mechanism of action– elevated levels of serotonin reduce
appetite Serotonin levels increase after eatingserotonergic drugs
–Increase release of serotonin
Serotonergic DrugsSerotonergic DrugsA shaky historyA shaky history
FenfluramineDexfenfluramine (Redux)1997 FDA withdrew approval
status– Heart valve damage– Primary pulmonary hypertension
Appetite Suppresants:Appetite Suppresants:
Noradrenergic DrugsNoradrenergic Drugs
Mechanism of Action–elevation of norepinephrine–associated with satiety
Eating increases norepinephrinenoradrenergic drugs
Noradrenergic DrugsNoradrenergic DrugsPhenterminePhenylpropanolamine
– Dexatrim, Acutrim, PPA– Also as decongestant in cold medications– OTC– FDA warnings ( 2004)
hemorrhagic strokeremoving PPA from all products
Drugs that increase both Drugs that increase both serotonin and norepinephrineserotonin and norepinephrine
Sibutramine (Meridia)– increases serotonin and
norepinephrine by inhibiting their re-uptake
–FDA approval 1997
Sibutramine (Meridia)Sibutramine (Meridia)Mean wt loss: 10-14 pounds
– effects vary substantially
Side effects:– hypertension– dry mouth– headache– constipation
no sign of heart valve problems or PPH
Sibutramine (Meridia)Sibutramine (Meridia)
FDA regulations– affect manufacturers’ advertisement/promotion– does NOT regulate how physicians prescribe – for obese clients (BMI>30) or– for overweight clients with health risks
(BMI>27)– safe for one year use
Combined Drug TreatmentCombined Drug Treatment
fen/phen– fenfluramine/phenteramine– “off label use”– FDA: not tested for safety or effectiveness– Fenfluramine banned– Other combinations:
Ephedra-phenteramine
Inhibitors of Nutrient Inhibitors of Nutrient AbsorptionAbsorption
Orlistat (Xenical) – FDA approved 1999– pancreatic lipase inhibitor
inhibits absorption of dietary fatscauses steatorrheamay psychologically reduce fat/caloric
intake
Inhibitors of Nutrient Inhibitors of Nutrient AbsorptionAbsorption
Dietary Supplements– Chitin (fat malabsorption)– Starch Blockers (alpha amylase
inhibitors)– like all dietary supplements:
not tested for safety or effectivenessnot “approved” by FDA
Metabolic Metabolic StimulantsStimulants
Thyroid Hormone– only useful if TH deficient (rare)– results in significant LBM loss
Ephedra– dietary supplement– FDA investigating adverse effect claims
regulatory status in question
Long-term pharmacotherapy for overweight and Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis obesity: a systematic review and meta-analysis
of randomized controlled trials.of randomized controlled trials.Int. J. Obesity & Related Met. Dis. 27:1437-1446 (2003)Int. J. Obesity & Related Met. Dis. 27:1437-1446 (2003)
RCT’s published between 1966-2002– Double blind RCT of > 1 yr– BMI > 30 + comorbidities– Only two drugs w/ studies meeting these
criteria Orlistat/Xenical (11 studies, n=6021, mean
BMI=35.7, predominantly white females) Sibutramine/Meridia (3 studies, n=929, mean
BMI=33.4, predominantly white females)
Long-term pharmacotherapy for overweight and Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis obesity: a systematic review and meta-analysis
of randomized controlled trials.of randomized controlled trials.
Orlistat (Xenical)Mean weight loss = 2.7 kg
– 2.9% greater than placebo– 12% lost > 10% of body weight
33% attrition rateReductions in serum lipids, serum glucose,
blood pressure, lower HDL-CGastro-intestinal side effects
Long-term pharmacotherapy for overweight and Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis obesity: a systematic review and meta-analysis
of randomized controlled trials.of randomized controlled trials.
Sibutramine (Meridia)Mean weight loss = 4.3 kg
– 4.6% wt loss– 15% lost > 10% of body weight
48% attrition rateLower reductions in serum lipids than
orlistatIncreased blood pressure and pulse rate