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Pharmacological Management of the Patient with Obesity
Published in James M. Rippe, Lifestyle Medicine, 2019
Magdalena Pasarica, Nikhil V. Dhurandhar
Phentermine is the most commonly prescribed obesity drug in the United States, as shown by the 2012–2015 National Prescription Audit database. U.S. providers prescribe phentermine nearly two times more compared with other weight loss drugs.14 The FDA approved phentermine for short-term treatment of obesity in 1959, and it is a schedule IV drug. It is approved for short-term weight loss as an adjunct to lifestyle changes in patients with a BMI of 30 kg/m2 or greater or patients with a BMI of 27 kg/m2or greater in the presence of at least one weight-related comorbidity. However, reports show that in practice it is also commonly used for longer periods.15 It is a centrally active adrenergic drug, a sympathomimetic amine that stimulates norepinephrine release in synaptic terminals. With phentermine use, patients can experience increased satiety and less hunger, craving, binging, and night time eating. Clinical trials show effectiveness and safety16,17 including studies in combination with fenfluramine.18–21 Due to a possible association with valvular heart disease, fenfluramine was removed from the market by the FDA in 1997. Phentermine was not shown to contribute to valvular heart disease and was not withdrawn.
Management of Obesity-Associated Type 2 Diabetes
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Wanda C. Lakey, Lillian F. Lien, Mark N. Feinglos
A combination drug therapy with phentermine and topiramate has been approved by the FDA for long-term weight management. Phentermine, a sympathomimetic amine, decreases appetite and food consumption by stimulating catecholamine release from the hypothalamus [170]. The exact mechanism for appetite suppression associated with topiramate, an antiepileptic, is not entirely understood [170]. In a randomized, controlled trial, obese adults were assigned a calorically restricted diet and randomized to phentermine/topiramate (3.75/23 mg or 15/92 mg) or placebo for 56 weeks [171]. A greater proportion of patients receiving phentermine/topiramate 3.75/23 mg (44.9%) and 15/92 mg (66.7%) lost 5% or greater of their baseline weight compared to placebo (17.3%) (P < .0001). In addition, patients receiving phentermine/topiramate 15/92 mg had significantly greater changes in fasting glucose, lipid parameters, systolic blood pressure, and waist circumference compared to placebo. Common side effects with phentermine/topiramate include paresthesias, xerostomia, dysgeusia, insomnia, and constipation [97,102,170,171]. Tachycardia may occur and heart rate should be monitored. Pregnancy is a contraindication for phentermine/topiramate use [97,102,170].
Obesity and diet
Published in Clive Handler, Gerry Coghlan, Marie-Anne Essam, Preventing Cardiovascular Disease in Primary Care, 2018
Clive Handler, Gerry Coghlan, Marie-Anne Essam
Dexfenfluramine, fenfluramine and amphetamines should no longer be prescribed for obesity. They cause pulmonary hypertension and valvular heart disease. There is no evidence that methylcellulose is effective or safe. Phentermine is a catecholamine-releasing agent stimulating the central nervous system causing appetite suppression. It should not be prescribed because its efficacy and safety have not been established.
A narrative review of anti-obesity medications for obese patients with osteoarthritis
Published in Expert Opinion on Pharmacotherapy, 2022
Win Min Oo, Ali Mobasheri, David J Hunter
Before FDA approval of Semaglutide, several meta-analyses reported that phentermine/topiramate provided the greatest magnitude of weight loss among the anti-obesity medications [98,99]. The weight loss effect and safety profile are dose-dependent, and the commonest adverse effects are dysgeusia (odds ratio [OR] = 8.86, 95% CI: 5.65–13.89), paresthesia (OR = 8.51, 95% CI: 6.20–11.67), dry mouth (OR = 6.71, 95% CI: 5.03–8.94) [100]. It carries a warning for increased heart rate (>5 to >20 beats/min [101]), particularly in patients with known cardiac or cerebrovascular diseases [95,102]. In the recent retrospective study (n = 13,972) using outpatient information from an electronic health record, longer term phentermine use revealed no increase in risk for incident cardiovascular events or death over 3 years of follow-up in a population without diagnosis and/or procedure codes for any cardiovascular disease [103]. The European Medicines Agency (EMA) refused its marketing authorization due to safety concerns such as effects on the cardiovascular system, psychiatric and cognitive effects, teratogenic risk (cleft lip/palate), and off-label use [104]. Patients who do not achieve at least 5% of weight loss after 12 weeks on the full dose should discontinue it after tapering over 1 week [95,102].
Screening of Weight-Loss Herbal Products for Synthetic Anti-Obesity Adulterants: A Target-Oriented Analysis by Liquid Chromatography–Tandem Mass Spectrometry
Published in Journal of Dietary Supplements, 2021
P. Girish, M. Jayanthi, B. Gitanjali, S. Manikandan, S. Rajan
Obesity is one of the non-contagious diseases that plays a significant role in the global health burden. Globally it was estimated that more than 650 million were obese (WHO, 2018). The extrapolated results from a recent study in India reported that the prevalence of generalized obesity was an estimated 135 million (Pradeepa et al. 2015). Difficulty in making long-term changes in diet and regular physical activity persuades obese individuals toward pharmacological management. However, the current pharmacological strategies are limited, and available allopathic drugs are reported to cause severe adverse effects after long-term use. Orlistat, a pancreatic lipase inhibitor, is the only allopathic medicine for the long-term management of obesity approved by the U.S. Food and Drug Administration. Appetite suppressants such as phentermine and diethylpropion are approved drugs for the short-term management of obesity. Anticonvulsants such as zonisamide and topiramate are used as off-label drugs for the management of obesity. Some of the previously approved anti-obesity drugs such as fenfluramine, dexfenfluramine, rimonabant, sibutramine, and 2,4-dinitrophenol (2,4-DNP) were withdrawn or banned for human use due to severe adverse effects such as cardiotoxicity and psychiatric complications (Kang & Park 2012; Yen & Ewald 2012).
The risk of cardiovascular complications with current obesity drugs
Published in Expert Opinion on Drug Safety, 2020
Ariana M. Chao, Thomas A. Wadden, Robert I. Berkowitz, Kerry Quigley, Frank Silvestry
Phentermine and topiramate were both approved by the FDA as individual medications prior to the approval of the combined product for chronic weight management in 2012. Phentermine is a sympathomimetic amine anorectic that was approved in 1959 for short-term (<3 months) treatment of obesity[27]. Topiramate is an anti-epileptic medication that modifies voltage-gate sodium and calcium channels and targets gamma-aminobutyric acid-mediated pathways[28]. Topiramate is approved for the treatment of epilepsy and migraine prophylaxis. The exact mechanism of action for weight loss is not known. The fixed-dose combination medication is started at a dose of 3.75 mg of phentermine and 23 mg of topiramate ER, once daily in the morning, and titrated to a recommended dose of 7.5 mg/46 mg[29]. The dose can be further increased to 15 mg/92 mg if 3% weight loss is not achieved after 12 weeks. The medication should be discontinued after 12 weeks if a 5% weight loss is not achieved after reaching 15 mg/92 mg.