Term
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Definition
-Amphetamine like
Mechanism of Action and Effects:
Amphetamine derivative, sympathomimetic amine
Releases dopamine, other biogenic amines
Inhibits neuronal and vesicular monoamine transporters
Inhibits MAO
CNS stimulant with little peripheral effect at low doses compared to amphetamine
Higher doses → cardiac stimulation, blood pressure, cardiac output
High abuse potential
Indication: Exogenous Obesity
Short-term adjunctive therapy for patients refractory to standard therapies (repeated diets and other drugs)
Tolerance to the anorectic effect occurs within a few weeks
Risk vs. Benefit: limited effect with significant risks:
Drug abuse
Hypertension
Tachycardia
Increased risk of stroke, MI
Insomnia
Contraindications: cardiovascular disease, hypertension, hyperthyroidism, history of drug abuse
Drug interactions: should not be combined with MAOIs or other CNS stimulants. May decrease effectiveness of guanethidine used to treat hypertension. |
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Term
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Definition
-Amphetamine like
Mechanism of Action:
Amphetamine derivative
Sympathomimetic, CNS stimulant
Increased norepinephrine release from central noradrenergic neurons
Combination with fenfluramine (Fen/Phen®) or with dexfenfluramine (Redux®) no longer marketed due to incidence of pulmonary hypertension and heart valve abnormalities
Effectiveness:
2-10 kg loss of original weight as long as the drug is taken
Weight regained once therapy ceases- used chronically
Adverse Effects:
Drug mouth, insomnia, constipation
Hypertension, tachycardia
Abuse liability thought to be low
Drug Interactions:
MAOIs, guanethidine, other CNS stimulants, alcohol, sibutramine and tricyclic antidepressants
Contraindications:
Hypertension, advanced cardiovascular disease, hyperthyroidism, glaucoma, anxiety and history of drug abuse |
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Term
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Definition
(Withdrawn Oct 2010)
Mechanism of Action:
Mixed adrenergic/serotonergic effects
Inhibits the reuptake of norepinephrine, serotonin, and dopamine
Effectiveness:
10% loss of original weight as long as the drug is taken
Weight regained once therapy ceases- used chronically
Adverse Effects:
Drug mouth, insomnia, constipation and asthenia
Hypertension and tachycardia- requires monitoring
Abuse liability is thought to be low, but still unknown
Drug Interactions:
SSRIs, MAOIs, other centrally active anorexiants, sumatriptin, dihydroergotamine, dextromethorphan, meperidine, pentazocine, fentanyl, lithium and tryptophan
Contraindications:
Uncontrolled hypertension
Severe renal impairment or hepatic dysfunction
History of substance abuse, coronary artery disease, congestive heart failure, arrhythmias or stroke |
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Term
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Definition
*lipase inhibitor
Mechanism of Action:
Inhibition of gastrointestinal lipases
Inhibits hydrolysis of triglycerides
Reduces dietary fat absorption 30%
Effectiveness:
Loss of 8-10% of original weight
Improvement in HA1C in Type II diabetics
Weight regained once therapy ceases- used chronically
Adverse Effects:
Gas, oily stools
Increased frequency of defecation
9% of patients discontinue treatment
Decreased absorption of fat soluble vitamins such as vitamin D and K, and ß-carotene
Drug Interactions:
Cyclosporine
Contraindications:
Chronic malabsorption syndrome
Cholestitis |
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Term
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Definition
-diabetes drug
Oral antihyperglycemic used to treat type 2 diabetes
Efficacy in producing weight loss well documented
Mechanism of Action: activation of 5’AMP-activated protein kinase (AMPK), a metabolic stress-sensing protein kinase that regulates multiple enzymes involved in the response to energy demand |
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Term
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Definition
-antiepileptic
Produces weight loss in patients with epilepsy
Increased weight loss in combination with caloric restriction: up to 6.3% in 6 months vs. 2.6% with placebo
Longer durations and higher doses are more effective, but can be associated with adverse neurological and psychiatric effects |
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Term
| Antidepressants for weight loss |
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Definition
SSRIs: fluoxetine (Prozac®, etc.), setraline (Zoloft®, ect.), paroxetine(Paxil®, etc.)
Increase weight loss in combination with caloric restriction for up to a year
Weight gain associated with long-term use
Bupropion (Wellbutrin SR®)
Non-SSRI antidepressant
Modestly effective when added to a program of caloric restriction |
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Term
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Definition
THC (-9-tetrahydrocannabinol, dronabinol, Marinol®)
Antiemetic and appetite stimulant
some studies suggest that dronabinol is not as effective as the smoked form: dosing and delivery
Useful in patients with AIDS and those undergoing chemotherapy |
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