Prescription MedicationsMajor Categories of Weight Loss DrugsAppetite Suppressants: Serotonergic DrugsSerotonergic Drugs A shaky historyAppetite Suppresants: Noradrenergic DrugsNoradrenergic DrugsDrugs that increase both serotonin and norepinephrineSibutramine (Meridia)Slide 9Combined Drug TreatmentInhibitors of Nutrient AbsorptionSlide 12Metabolic StimulantsLong-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int. J. Obesity & Related Met. Dis. 27:1437-1446 (2003)Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials.Slide 16Prescription Prescription MedicationsMedicationsDavid L. Gee, PhDProfessor of Food Science and NutritionCentral Washington UniversityMajor Categories of Major Categories of Weight Loss DrugsWeight Loss DrugsAppetite SuppressantsInhibitors 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 eatingserotonergic drugs–Increase release of serotoninSerotonergic DrugsSerotonergic DrugsA shaky historyA shaky history FenfluramineDexfenfluramine (Redux)1997 FDA withdrew approval status–Heart valve damage–Primary pulmonary hypertensionAppetite Suppresants:Appetite Suppresants:Noradrenergic DrugsNoradrenergic DrugsMechanism of Action–elevation of norepinephrine–associated with satietyEating increases norepinephrinenoradrenergic drugsNoradrenergic DrugsNoradrenergic DrugsPhenterminePhenylpropanolamine –Dexatrim, Acutrim, PPA–Also as decongestant in cold medications–OTC–FDA warnings ( 2004)hemorrhagic strokeremoving PPA from all productsDrugs 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 1997Sibutramine (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 PPHSibutramine (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 useCombined Drug TreatmentCombined Drug Treatmentfen/phen–fenfluramine/phenteramine–“off label use”–FDA: not tested for safety or effectiveness–Fenfluramine banned–Other combinations:Ephedra-phenteramineInhibitors of Nutrient Inhibitors of Nutrient AbsorptionAbsorptionOrlistat (Xenical) –FDA approved 1999–pancreatic lipase inhibitorinhibits absorption of dietary fatscauses steatorrheamay psychologically reduce fat/caloric intakeInhibitors 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 effectivenessnot “approved” by FDAMetabolic 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 questionLong-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 rateReductions in serum lipids, serum glucose, blood pressure, lower HDL-CGastro-intestinal side effectsLong-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 rateLower reductions in serum lipids than orlistatIncreased blood pressure and pulse