Fenfluramine-Phentermine

Although withdrawn from the market, several studies have examined the effectiveness of treatment with drug combinations along with a behavior modification component. Smaller doses of each medication can be effective, thus reducing adverse side effects, resulting in an overall 9.4 plus/minus 0.8 kg (20 pounds) weight loss after 3 years, with a plateau in weight loss at 18-20 weeks.

This is consistent with the recent open label trials at M.D. Weight Care done by Leo J. Borrell, M.D., with over 2000 patients in Houston enrolled in a comprehensive behavioral pharmacotherapy obesity treatment program. They reported average weight losses of 16.5 kg (35 pounds) and weight loss maintenance for 18 months, which shows the intensity of psycho-social contact correlated directly with weight (i.e., 2-4 pounds/month/visit).

At M.D. Weight Care this observation is substantiated by our cohort, in which the most frequently reported side effects at the follow-up were dry mouth (73%), drowsiness (22%), and constipation (16%) or diarrhea (16%). By the sixth follow-up, these complaints dropped to 55%, 5%, 10% and 2%, respectively. If the patient is informed of this, they are well-tolerated and attrition decreases.

Fluoxetine (Prozac)

Evaluated in several clinical trials, although it is not approved by the FDA for the treatment of obesity, Fluoxetine treatment produces significant initial weight losses up to 24 weeks.

The combination of fluoxetine and Prozac has been used to enhance dietary restraint and reduce hunger in daytime, while the addition of dexfenfluramine at dinner might effectively control binging. Fluoxetine-dexfenfluramine combination lost significantly more weight than patients who received fluoxetine (13.4 plus/minus 6.3 kg vs. 6.2 plus/minus 2.8 kg, respectively). This combination is more effective at producing short-term weight loss than either fluoxetine or dexfenfluramine alone. The addition of dexfenfluramine appeared to prevent weight gain during active treatment reported in previous fluoxetine studies.

Fluoxetine (Prozac) is not FDA approved for weight loss, but has shown results of high initial weight loss. Recent studies by Dr. Michael Anchors, author of Safer Than Phen-Fen, show it is more effective than fenfluramine. Prozac causes weight gain after 6 months unless combined with phentermine.

Sertraline

A serotonin inhibitor used in the treatment of depression, following a very low calorie diet (VLCD) demonstrated some long-term advantage over placebo.

Ephedrine-Caffeine

Several randomized, double-blind, placebo-controlled trials of ephedrine, a stimulant anorexiant, usually in combination with caffeine and aspirin, produced greater weight loss than dietary restriction alone (no more than 4 kg/10 pounds after 24 weeks). The ephedrine-caffeine combination is not approved for the treatment of obesity and the FDA recently has expressed serious concerns about the safety of ephedrine.

Although theoretically it appears to be beneficial, from practical experience there is not much benefit. The FDA has 38 deaths associated with its use. Because of this, the FDA recommends no more than 30mg per day should be used. Metabolite contains Ephedrine and should be used with caution. For more information, go to the FDA home page.

Other Drugs

Anorexiant medications, including mazindol, diethylpropion, and phenylpropanolamine have produced modest weight loss of 4-10 pounds over 6 to 12 months.

Recently Approved and Future Drugs

New pharmacotherapies (i.e., Xenical) can reduce energy intake, reduce nutrient absorption, or increase energy expenditure. It is due to be released in 1998.

Xenical

What is Xenical?

An oral medication that works on the intestines which blocks some of the fat from being absorbed and the undigested fat is eliminated.

Who is a good candidate for Xenical?

• People who are 30% above their ideal weight

• People who have a BMI of 30 or higher

• People who are 20% above their ideal weight and have a BMI of 27 or higher

• People who have other risk factors, like high blood pressure, high cholesterol, heart disease or diabetes

Who is not a good candidate for Xenical?

• People with chronic malabsorption

• People with gall bladder problems

• Women who are pregnant or breast feeding

• People who have an allergic reaction to Orlistat or any of the active ingredients in Xenical

How Well Does it Work?

Weight loss is gradual A 6-12 month program is required along with a reduced calorie and low fat diet Xenical will make you lose twice the weight than dieting alone

Lifestyle Changes to Make

• Low-fat meals (balanced-fat, carbohydrates and protein)

• You must eat your 3 meals a day

• Exercise like walking is highly recommended

• Multivitamins must be taken at bedtime

Side Effects

During the first few weeks of treatment:

• Oily spotting

• Gas with discharge

• Urgent need to go to the bathroom

• Oily/fatty stools

• Oily discharge

• Inability to control bowels

• Bowel movements can be orange/brown

Contraindications to Use Xenical

• Allergic to other medicines, foods or dyes

• Taking any other weight loss medication

• Taking cyclosporine

• Taking any other medications (including those not prescribed by your doctor)

• Planning to become pregnant

• Anorexic or bulemic

Products sold over-the-counter - such as phenprepyline (i.e., Dexatrim), although previously tested and shown as effective by advertisers, has not proven to be reliable by acceptable scientific standards and is not advised for patients with hypertension because of the risk of stroke.

Other Drugs are soon to be released. Orlistat, a fat blocker, shows only 5% weight loss. Meridia - Sibutramine (with action like phen/fen) is now available. Information will be avialable regarding this drug here soon. If you would like further information, contact us.