Each overweight individual has a different reason for his weight gain - it may be eating very large meals, cravings, eating out of anxiety or boredom or even eating in the middle of the night. You need to first identify your particular eating problem and then find a food plan that best matches your food preferences and personal requirements. The role of medication is to assist individuals who are having difficulty with hunger, cravings and compulsive eating. Diet drugs, even then strongest, are not "magic bullets," only "helpers", and that even the strongest pill cannot stop one from eating some very bad, readily available foods.
Dietary changes, even simple ones, always come before medications. Taking these medications, even for brief periods of times often assists individuals in their weight loss plan. Some individuals experience fullness for the first time in their lives while others feel in control of their food and learn to make better food decisions. Many overweight people learn that they genuinely do not need as much food as they had once believed they did.
While some individuals might do well taking the drugs for only a couple of weeks to help "jump start" their weight loss plan, others may need to take them for months or even years. Since each overweight individual has a different reason for his weight gain, the right drug needs to be matched with the "right person"-not only in choice of drugs, but dose and duration.
Here is an overview of the prescription obesity drugs choices today:
Phentermine: Ionamin, Adipex
Phendimetrazine:Bontril
Diethylpropion: Tenuate
Subutramine: Meridia
Xenical: orilstat
First approved as an appetite suppressant in 1959, Phentermine is sold under a variety of brand names including Ionamin and Bontril as well as under its generic name. Phentermine and its cousins Phendimetrazine and Diethylpropion are all sympathomimetic amines, which are similar to an amphetamine. They are also known as an "anorectic" or "anorexigenic" drugs. They stimulate the central nervous system (nerves and brain), which raises your heart rate and blood pressure as it suppresses your appetite. Dr. Weintraub, in groundbreaking studies combined phenteramine with fenfluramine in a combination called Fen-phen. Interest in these drugs peaked in the mid 1990's when you could find a doctor on virtually every street corner who prescribed them. The rare occurrence of heart disease and even rarer pulmonary hypertension led to the withdrawal of the drugs from the market in 1997. The 1990's and early 2000's saw the use of herbal fen/phen and combinations of Phentermine and Prozac all without significant weight-loss benefits.
Nonetheless, these drugs still play a role in weight loss and have been taken by millions of people over the past 25 years.
How it Works, Side Effects, Who Should Take It
Phentermine, Phendimetrazine and Diethylpropion are closely related drugs that reduce appetite but have little effect on cravings and compulsive eating. They raise blood pressure in some individuals and often are limited by the development of tolerance in others. These are useful drugs for those who simply eat too much, particularly during the day when these drugs are the most effective.They need to be used with caution in people with high blood pressure. They should not be used either in people who have heart disease, who have had strokes, or other serious brain or cardiac problems. These drugs are most effective when used in low doses and titrated slowly to avoid side effects and the development of tolerance. Some physicians alternate Phentermine with Phendimetrazine in order to avoid tolerance. Of all of the drugs in this group, Diethylpropion has the least side effects and the least problems with tolerance. Related to bupropion, Wellbutrin, not only reduces appetite but helps many people with compulsive eating.
Subutramine
Approved by the U.S. FDA in 1997, Meridia (sibutramine) is thought to decrease appetite by inhibiting the re-uptake of serotonin, nor epinephrine, and dopamine in the brain. By doing this, it helps increase the levels of these hormones that control appetite and hunger. It was the first selective serotonin reuptake inhibitor (SSRI) to be used specifically for weight loss, although other drugs in the same class such as prozac and paxil have been used as anti-depressants.. The drug causes a small increase in average blood pressure and heart rate.
It was released right after the phen-fen problems of the late 1990's and has not had widespread use.
Sibutramine reduces appetite and produces fullness resulting in early satiety. Other than some elevated blood pressure in some individuals, this is an effective drug, especially for those with cravings and compulsive eating. The feelings of fullness rather than appetite reduction may be the most significant effect. This is a drug approved for long-term use-months and even years. It has substantial benefits for those individuals who have a great deal of weight to lose and are willing to take the drug for long periods of time.
Orlistat
Approved by the U.S. FDA in 1999, Xenical (orlistat) is a lipase inhibitor for obesity management that acts by inhibiting the absorption of dietary fats. Orilstat prevents enzymes in the gastrointestinal tract from breaking down dietary fats into smaller molecules that can be absorbed by the body. This undigested fat is excreted in the bowel movement. Side effects of flatulence, fecal urgency, oily stools and leakage have limited its widespread use. An over-the-counter version, brand name Alli has been on the market for the past two years,
While it is expensive and has limited benefits, some studies show that teenagers have done well with it.
New Weight Loss Drugs for 2010:
After the cannabinoid receptor antagonist, drug Rimbonbant (Acomplia) was rejected by the FDA because of psychiatric problems and latter pulled off the European market, focus in the US has been on combining older drugs, each having different effects. This has been used very successfully in the treatment of hypertension, diabetes, and high cholesterol. Doses can be kept low and there are synergistic effect of taking two drugs, each one at lower doses. Three combinations of older drugs are being tested:
Qnexia-phentermine and topamax
Empatic-buprion and zonisamide
Contrave-Buproion and Naltrexone
Of these three, the best result seem to have been from Contrave, which reminds one of phen/fen, only the fenfluramine has be substituted by the migraine/headache pill, Topamax. I have prescribed this combination of pills, off label, and have very good results, especially in patients who are eating out of cravings or emotion issues and not even hungry. The greatest side effect was fatigue and sleepiness.
Another approach has been to use the GLP-1 antagonists used for treating diabetes including Pramlintide,Exenatide and Symylin. The down side is that they have to be given by injection once or twice a day. A long acting once a week injection is being tested which may offer a lot of advantages to obese diabetics and people with morbid obesity. The drugs normalize blood sugars(but do not cause them to fall below normal), decrease gastric emptying time so a person is full longer, and may actually decrease appetite through central nervous system pathways.
Every pharmaceutical company is looking at this market, and no doubt in the next few years, new and exciting medication will be available to assist the overweight person. However, medications are only helpers, not much different than bariatric sugery in that people still need to pay attention to the food and move around more.If you are considering medications, you need to see a physician who is experienced with these medications.They are prescription medications (except for Alli) and all have significant side effects if not taken corrrectly.
Buying these kinds of drugs on the Internet is dangerous, you don't know what is the best drug for you nor do you have any idea even what you are buying. Visit an M.D. or D.O., weight loss is a serious business. Treat your body as carefully as you take care of your computer or car. You will also save a lot of money, Internet prices are often four to five times what you would pay in a drugstore!
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