Prescription medications for the treatment of obesity

Discussion in 'Useful info on weight loss' started by Kate, Mar 23, 2010.

  1. Kate

    Kate Administrator
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    Obesity is a chronic disease that affects many people and often requires long-term treatment to promote and sustain weight loss. As in other chronic conditions, such as diabetes or high blood pressure, long-term use of prescription medications may be appropriate for some individuals.

    While most side effects of prescription medications for obesity are mild, serious complications have been reported. Valvular heart disease has recently been reported to occur in association with the use of certain appetite suppressant medications.

    As a result of these reports, the manufacturer has voluntarily withdrawn two medications, fenfluramine (Pondimin) and dexfenfluramine (Redux) from the market. There are few long-term studies evaluating the safety or effectiveness of other currently approved appetite suppressant medications. In particular, the safety and effectiveness of combining more than one appetite suppressant medication or combining appetite suppressant medications with other medications for the purpose of weight loss is unknown.

    Appetite suppressant medications should be used only by patients who are at increased medical risk because of their obesity and should not be used for "cosmetic" weight loss.

    Medications That Promote Weight Loss

    The medications most often used in the management of obesity are commonly known as "appetite suppressant" medications. Appetite suppressant medications promote weight loss by decreasing appetite or increasing the feeling of being full. These medications decrease appetite by increasing serotonin or catecholamine--two brain chemicals that affect mood and appetite.

    Most currently available appetite suppressant medications are approved by the U.S. Food and Drug Administration (FDA) for short-term use, meaning a few weeks or months. Sibutramine is the only appetite suppresant medication approved for longer-term use in significantly obese patients, although the safety and effectiveness have not been established for use beyond one year. (See table 1 for the generic and trade names of prescription appetite suppressant medications.)

    While the FDA regulates how a medication can be advertised or promoted by the manufacturer, these regulations do not restrict a doctor's ability to prescribe the medication for different conditions, in different doses, or for different lengths of time. The practice of prescribing medication for periods of time or for conditions not approved is known as "off-label" use. While such use often occurs in the treatment of many conditions, you should feel comfortable about asking your doctor if he or she is using a medication or combination of medications in a manner that is not approved by the FDA.

    The use of more than one appetite suppressant medication at a time (combined drug treatment) is an example of an off-label use. Using currently approved appetite suppressant medication for more than a short period of time (i.e., more than "a few weeks" is also considered off-label use.

    Single Drug Treatment

    Several appetite suppressant medications are available to treat obesity. In general, these medications are modestly effective, leading to an average weight loss of 5 to 22 pounds above that expected with non-drug obesity treatments. People respond differently to appetite suppressant medications, and some people experience more weight loss than others.

    Some obese patients using medication lose more than 10 percent of their starting body weight--an amount of weight loss that may reduce risk factors for obesity-related diseases, such as high blood pressure or diabetes. Maximum weight loss usually occurs within 6 months of starting medication treatment. Weight then tends to level off or increase during the remainder of treatment.

    Studies suggest that if a patient does not lose at least 4 pounds over 4 weeks on a particular medication, then that medication is unlikely to help the patient achieve significant weight loss. Few studies have looked at how safe or effective these medications are when taken for more than 1 year.

    Some antidepressant medications have been studied as appetite suppressant medications. While these medications are FDA approved for the treatment of depression, their use in weight loss is an "off-label" use. Studies of these medications generally have found that patients lost modest amounts of weight for up to 6 months. However, most studies have found that patients who lost weight while taking antidepressant medications tended to regain weight while they were still on the drug treatment.

    NOTE: Amphetamines and closely-related compounds are not recommended for use in the treatment of obesity due to their potential for abuse and dependence.

    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. Little information is available about the safety or effectiveness of other drug combinations for weight loss, including fluoxetine/phentermine, phendimetrazine/phentermine, herbal combinations, or others.

    Until more information on their safety or effectiveness is available, using combinations of medications for weight loss is not recommended except as part of a research study.

    Potential RIsks of Medication Treatment

    When considering long-term appetite suppressant medication treatment for obesity, you should consider the following areas of concern and potential risks.

    Potential for Abuse or Dependence
    Currently, all prescription medications to treat obesity are controlled substances, meaning doctors need to follow certain restrictions when prescribing appetite suppressant medications. Although abuse and dependence are not common with non-amphetamine appetite suppressant medications, doctors should be cautious when they prescribe these medications for patients with a history of alcohol or other drug abuse.

    Development of Tolerance
    Most studies of appetite suppressant medications show that a patient's weight tends to level off after 4 to 6 months while still on medication treatment. While some patients and physicians may be concerned that this shows tolerance to the medications, the leveling off may mean that the medication has reached its limit of effectiveness. Based on the currently available studies, it is not clear if weight gain with continuing treatment is due to drug tolerance.

    Reluctance to View Obesity As a Chronic Disease
    Obesity often is viewed as the result of a lack of willpower, weakness, or a lifestyle "choice"--the choice to overeat and underexercise. The belief that persons choose to be obese adds to the hesitation of health professionals and patients to accept the use of long-term appetite suppressant medication treatment to manage obesity. Obesity, however, is more appropriately considered a chronic disease than a lifestyle choice.

    Other chronic diseases, such as diabetes and high blood pressure, are managed by long-term drug treatment, even though these diseases also improve with changes in lifestyle, such as diet and exercise. Although this issue may concern physicians and patients, social views on obesity should not prevent patients from seeking medical treatment to prevent health risks that can cause serious illness and death.

    Appetite suppressant medications are not "magic bullets," or a one-shot fix. They cannot take the place of improving one's diet and becoming more physically active. The major role of medications appears to be to help a person stay on a diet and exercise plan to lose weight and keep it off.
     
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  2. msnweather

    msnweather Guest

    Hello every one

    Hi, I am newbie.This is my frist post ...lol.
    say hi to all.
     
  3. Kate

    Kate Administrator
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    Your are welcome! ;)
     
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