Phentermine can be associated with many side effects such as dry mouth, constipation, insomnia, nervousness, agitation, tremor, increase in blood pressure, and pulse rate. Phentermine should not be taken by patients who have previous heart attack, heart rhythm disturbance, stroke or uncontrolled blood pressure. Phentermine can rarely be addictive.
Medications FDA approved for other disorders but can be prescribed “off label” for weight loss or as a “two for one”:
- Adderall XR (Amphetamine extended release): Adderall XR is a stimulant medication that is approved for the treatment of ADHD in children and adults. It works by increasing the amount of the neurochemicals dopamine and norepinepherine in the brain which is associated with an increased state of alertness and focus. It can often be associated with a decrease in appetite and weight loss. There are no controlled studies specifically investigating Adderall XR for the treatment of Overweight/Obesity.
The most common side effects of Adderall XR are dry mouth, loss of appetite, insomnia, and headache. Adderall XR should not be taken by patients who have uncontrolled high blood pressure, previous stroke or heart attack, uncontrolled glaucoma, or emotional instability. Most individuals can use Adderall XR safely, however, Adderall XR is an amphetamine and abuse may lead to dependence. Misuse may lead to serious adverse cardiovascular events.
- Byetta (Exanidate) Byetta was approved for Type 2 Diabetes and hit the shelves in June 2005. It is the first drug in its class called incretin mimetics. This medicine increases gut hormones that help regulate blood sugar and insulin levels thus improving diabetes control without causing hypoglycemia or low blood sugar. One of its most common side effects is weight loss which is exactly what most people with Type 2 Diabetes need. This medicine must be injected subcutaneously twice daily with meals, but is conveniently packaged in order to make this simple and painless.
The most common side effects are transient nausea, vomiting and diarrhea, headache, dizziness, feeling jittery, weakness or unusual sweating. There are no controlled studies specifically investigating the use of Byetta for the treatment of Overweight/Obesity. Studies for Byetta in the treatment of Type 2 Diabetes showed a statistically significant weight loss for subjects receiving Byetta compared to subjects receiving placebo.
- Glucophage (Metformin)
Glucophage is a medication that has been around for nearly 20 years and is FDA approved for Diabetes. Unlike most other medications for diabetes which can cause weight gain, Glucophage typically leads to weight loss as well as to a decrease in blood pressure and cholesterol. Glucophage virtually never causes a severe lowering of blood sugar or hypoglycemia even in patients who have a normal range blood sugar to begin with. Glucophage must not be used in patients with impaired liver or kidney function and must be taken with food in order to diminish its gastrointestinal side effects. There is ample evidence to support the prescribing of Metformin in overweight/obese patients both with and without diabetes.
- Provigil (Madofinil) Provigil is an FDA-approved medication indicated for the treatment of excessive day time sleepiness associated with Narcolepsy, Obstructive Sleep Apnea Syndrome and Shift Work Sleep Disorder. Provigil is classified as a stimulant medication, but has a mechanism of action that is distinctly different from other drugs in the stimulant class. This difference results in a calmer wakefulness than that associated with other stimulants. In some individuals it can cause appetite suppression and weight loss. However, there are no controlled studies specifically investigating Provigil in the treatment of overweight/obesity. The most common side effects of Provigil are anxiety, headache, nausea, nervousness, and trouble sleeping. It is typically very well tolerated and does help to improve day time wakefulness and alertness. It has been studied and may ultimately be FDA-approved for use in ADHD.
- Symlin (Pramlintide) Symlin is an injectable medication FDA-approved for the control of blood sugar levels in patients with diabetes already on Insulin. In addition to controlling blood sugar, it causes appetite suppression and weight loss; a very desirable side effect for a patient with diabetes that has Overweight/Obesity. The most common side effects include nausea and low blood sugar (hypoglycemia) requiring careful monitoring and frequent adjustments of the patients’ insulin injections. There is ample evidence that Symlin causes weight loss in patients with Type 2 Diabetes. The manufacturer of Symlin, Amylin, is in the midst of investigating the use of Symlin for the treatment of obesity in non-diabetic subjects and shows much promise for this use in the future.
- Topamax (Toperamide) and Zonegran (Zonisamide) Topamax and Zonegran are FDA-approved for long-term use in Epilepsy. Topamax has also been approved for the treatment of Migraine Headache. These medications have appetite suppressant side effects that seem to be more specific for binge eating and carbohydrate cravings such as those seen in Bulimia and Binge Eating Disorder (BED). It is estimated that up to 30% of obese individuals have BED. The dosage of these medications needed to treat obesity and binge eating is less than that required to treat seizures, significantly reducing their side effects, which include sedation, cognitive impairment and tingling sensations in the extremities called parasthesias. Topamax and Zonegran may increase the risk of forming kidney stones and may rarely cause an eye problem known as acute angle closure glaucoma. Many of the side effects can usually be avoided by very slow increases in the dosage until an effective appetite suppressant level is reached.
- Wellbutrin XL (Bupropion long acting). Wellbutrin has been around for nearly 20 years. It was originally FDA- approved for long term use in depression. In subsequently received FDA approval for smoking cessation. It works by increasing the levels of the stimulatory neurochemicals norepinepherine and dopamine in the brain. It appears that these same neurochemicals play an important role in mediating addictive behavior as well as appetite. It has anorexiant side effects (benefits). It is an ideal medication for overweight, depressed patients who also smoke. However, it can work as an appetite suppressant even in individuals who don’t smoke and are not depressed. There is evidence to support the use of Wellbutrin in the treatment of Overweight/Obesity. Side effects can include nervousness, insomnia and tremor. Wellbutrin should not be used in patients with a history of seizures.
This is Part Four 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.