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Prescription Medications David L. Gee, PhD Professor of Food Science and Nutrition Central Washington University
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Major Categories of Weight Loss Drugs Appetite Suppressants Inhibitors of Nutrient Absorption (Metabolic Stimulants)
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Appetite Suppressants: Serotonergic Drugs Mechanism of action – elevated levels of serotonin reduce appetite Serotonin levels increase after eating serotonergic drugs –Increase release of serotonin
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Serotonergic Drugs A shaky history Fenfluramine Dexfenfluramine (Redux) 1997 FDA withdrew approval status – Heart valve damage – Primary pulmonary hypertension
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Appetite Suppresants: Noradrenergic Drugs Mechanism of Action – elevation of norepinephrine – associated with satiety Eating increases norepinephrine noradrenergic drugs
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Noradrenergic Drugs Phentermine Phenylpropanolamine – Dexatrim, Acutrim, PPA – Also as decongestant in cold medications – OTC – FDA warnings ( 2004) hemorrhagic stroke removing PPA from all products
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Drugs that increase both serotonin and norepinephrine Sibutramine (Meridia) – increases serotonin and norepinephrine by inhibiting their re-uptake – FDA approval 1997
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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
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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
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Combined Drug Treatment fen/phen – fenfluramine/phenteramine – “off label use” – FDA: not tested for safety or effectiveness – Fenfluramine banned – Other combinations: Ephedra-phenteramine
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Inhibitors of Nutrient Absorption Orlistat (Xenical) – FDA approved 1999 – pancreatic lipase inhibitor inhibits absorption of dietary fats causes steatorrhea may psychologically reduce fat/caloric intake
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Inhibitors of Nutrient Absorption Dietary Supplements – Chitin (fat malabsorption) – Starch Blockers (alpha amylase inhibitors) – like all dietary supplements: not tested for safety or effectiveness not “approved” by FDA
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Metabolic Stimulants 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
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Long-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) 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)
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Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis 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 effects
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Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis 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 rate
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