1. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 82 Drugs for Weight Loss

2. 2 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Obesity  May be associated with hypertension, coronary heart disease, stroke, type 2 diabetes, gallbladder disease, kidney stones, osteoarthritis, sleep apnea, dementia, and certain cancers, although underweight or normal-weight patients also suffer from these conditions

3. 3 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Assessment of Obesity-Related Health Risk  Assessment: obesity 1.Degree of obesity  Body mass index (BMI) 2.Pattern of fat distribution  Waist circumference 3.Presence of risk factors  Coronary heart disease, diabetes, hypertension  Other atherosclerotic diseases, sleep apnea

4. 4 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Overview of Obesity Treatment  Who might want to be treated?  Body mass index (BMI) of 30 or more  BMI of 25 to 25.9 plus two risk factors  Weight circumference (WC) greater than 40 inches (in men) or greater than 35 inches (in women) plus two risk factors  Treatment goals

5. 5 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Treatment Modalities  Nutritious diet  Exercise  Behavior modification  Drug therapy  Bariatric therapy

6. 6 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Weight-Loss Drug  Only weight-loss drug currently approved for long-term use:  Orlistat (Xenical, Alli)

7. 7 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Sibutramine (Meridia)  Withdrawn in 2010 because of risk of stroke and myocardial infarction  Additional adverse effects included:  Headache  Dry mouth  Constipation  Elevated heart rate  Insomnia  Elevated blood pressure  Nervousness and anxiety

8. 8 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Orlistat (Xenical, Alli)  Acts in the GI tract to reduce absorption of fat  Adverse effects  GI effects  Fecal incontinence  Fecal urgency  Oily spotting  Oily stools  Can be reduced somewhat with decreased fat intake and psyllium  Reduced absorption of fat-soluble vitamins  Take vitamin supplement: 2-hour window

9. Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Orlistat (Xenical, Alli) ● Cautions  Vitamin K deficiency can intensify effects of warfarin  Associated with severe liver damage  May cause hypothyroidism in patients taking levothyroxine 9

10. 10 Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Miscellaneous Appetite Suppressants  Sympathomimetic amines  Nonamphetamines  Amphetamines  Bupropion  Fluoxetine  Topiramate and zonisamide