In many instances these eleven
medications may actually be prescribed for their FDA approved use while, at the
same time, taking advantage of their anorexiant effect to help patients lose
weight. Examples of this are the use of Topamax (Toperamide) to treat
Migraine Headaches or Seizure Disorders; Wellbutrin (Bupropion) to treat
Depression or Smoking Cessation; Adderall XR to treat Attention Deficit
Disorder; Glucophage (Metformin), Byetta (Exanidate) or Symlin
(Pramlintide) to treat Type 2 Diabetes Mellitus and Provigil
(Madofinil) in patients with Sleep Apnea, Shift Worker’s Sleep Disorder, and
Narcolepsy. In these cases the patient is getting a “two for one”
treating a medical problem with an FDA approved medication, while at the same
time benefiting from the anorexiant effect and weight loss that is a typical
side effect (side benefit) of the medication.
Below is a brief synopsis of the
medications prescribed in the Medicalizing Overweight/Obesity weight
management program: (Full prescribing information is provided at the time a
prescription is written.)
Medications FDA approved for
long-term use in the treatment of obesity and weight maintenance:
- Meridia (Sibutramine):
Meridia is classified as a serotonin/norepinephrine reuptake inhibitor (SNRI)
and was originally being studied to be an antidepressant medication when
it was serendipitously found to be an effective weight loss medication. It
has a similar mechanism of action as the commonly prescribed
antidepressants in that it enhances the activity of the neurochemicals,
serotonin and norepinephrine, in the central nervous system (CNS)
resulting in an increase in satiety with less food intake as well as an
increase in the metabolic rate resulting in weight loss.
Meridia has been
studied longer than any other appetite suppressant on the market with long-term
data confirming its safety and efficacy for up to 3 years of continuous use.
Most people lose approximately 10% of their initial body weight and maintain
most of this weight loss as long as the medication is taken. Weight loss
plateaus at approximately 6 months with a slight weight regain. Meridia has
been shown to be 4 times more effective than placebo in achieving a 10% weight
reduction in long-term studies.
Common side
effects of Meridia are dry mouth, constipation and insomnia. Rarely, Meridia
may cause a significant increase in blood pressure and pulse rate and this
should be closely monitored. If Meridia is going to affect blood pressure it
will do so within the first 2 weeks of therapy. Most side effects are mild and
transient. Patients with history of a prior heart attack, stroke, uncontrolled
high blood pressure or heart rhythm disorder should not take Meridia.
- Xenical (Orlistat): Xenical
is a nonsystemic medication (it does not get absorbed into the blood
stream) that blocks the fat absorbing enzyme, lipase, in the small
intestine and pancreas. Being taken 3 times per day with meals Xenical can
block the absorption of 1/3 of fat consumed in the diet which can result
in a 10% weight reduction in 6 months and maintain the majority of this
weight loss if the medication is taken continuously. Xenical works best in
conjunction with a low fat diet (30% of total calories consumed). Xenical
has been proven to prevent Type 2 Diabetes in obese patients.
Due to its
mechanism of action in blocking fat, malabsorption of fat with its resultant
oily stools, excess flatus, anal leakage, and fecal incontinence may cause
patients to discontinue this medication. However, with proper diet and the addition
of a fiber supplement such as Metamucil, anecdotal evidence suggests that these
side effects can be at least mitigated and even entirely avoided. Xenical needs
to be taken in conjunction with a standard multivitamin to avoid vitamin
deficiencies.
This is Part Three in a series of
articles on the topic of Medicalizing Overweight and Obesity, so make
sure to look at the next issues for the continuation.