In this society of the “quick fix,” the race is once again on to serve weight loss up in tablet form.
When I began practicing pharmacy some 30 years ago, it was common medical practice to prescribe thyroid hormone for weight loss; yes, even if your thyroid was functioning normally. This created a lot of issues as you can imagine, including heart problems, osteoporosis, hyperthermia and even death. What is the price we pay for skinny?
Then along came the popular “Fen-Phen” This combination produced some significant weight loss, but so do amphetamines, and not without some serious side effects such as high blood pressure, heart attack, stroke and pulmonary hypertension. Fen-Phen behaved liked a stimulant, as most drugs that increase metabolism will, and those that took it loved the energy and power of concentration these drugs gave them.
But if something seems too good to be true, it usually is. The drug was marketed as Redux®, a combination of phentermine and fenfluamine. The fenfluramine caused an increase in serotonin as well as other neurotransmitters, helping keep hunger at bay. The phentermine component increased metabolism and energy levels as well. The drug resulted in many deaths and injuries along with several million dollars worth of lawsuits against the company.
After this debacle another drug that stimulated serotonin, sibutramine or Meridia® was brought to the US market. Eventually, this drug was found to have cardiac risk factors in some patients that the FDA could not ignore. It was voluntarily withdrawn from the US market in 2010, but is still found as an illegal ingredient in this country in some over-the-counter products.
Then along came Xenical® which was touted as “a medication that works like no other medication." This medication (orlistat) is a fat blocker. It acts to block the normal absorption of fat. What could be better? Bring on the French fries!
Not so fast. As patients and health practitioners came to realize, weight loss with this drug came with a heavy price tag. Because fat was not absorbed properly when eaten, those on the drug experienced bloating, gas, diarrhea and, the most disturbing, “anal leakage.” There is also the possibility of poor absorption of some medications as well as fat-soluble vitamins. Xanical® can produce weight loss in the right patient, however, without the side effects such as increased heart rate and blood pressure,etc. that are seen in other weight loss products.
Next on the horizon is a drug that many people are anxiously awaiting called Qnexa®. This is a combination product containing phentermine and topiramate (which is currently used as an anti-seizure medication). Some studies have shown that this drug helps significantly with weight loss (up to 10 percent of body weight), but is not without side effects and warnings. There is a pregnancy warning as well as some cardiac concerns and other potential side effects.
Now as a pharmacist, I am well aware that every drug has potential side effects and that we must always weigh benefit versus risk. This drug will also have guidelines as with all medications in this class as to how it is used and which patient it may be good for. None of these aforementioned drugs should be used just to shed a “few pounds." The recommendation on Qnexa will probably be for a patient who has a BMI between 27-30 depending on several risk factors in the labeling.
There is also a drug you may come across that recently came out called Suprenza ODT®. This is a rapid-release form of another drug already out for many years called phentermine. As stated by the manufacturer, Supernal is indicated as a short-term (a few weeks) addition to a regimen of weight reduction based on exercise, behavioral modification and caloric restriction. It's meant for management of exogenous obesity for patients with an initial body mass index ≥ 30 kg/m2, or ≥ 27 kg/m2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia). Note that it is for short term use only, which means just a few weeks. This indication will probably be different when the FDA approves Qnexa®, as this will be more of a potential long -term use drug.
Let me be clear, these medications have their place, but they are not without potential side effects and doctors and other health care professionals need to use them with caution. Some patients with diabetes may benefit, but nothing, I repeat nothing, can replace eating right and exercise. It is true that we all may need help of some sort, and with proper physician monitoring the right patient can do well on many of these medications.
As far as the many over the counter weight loss supplements go, they are not proven to be very effective. A recent study was published in Science Daily (March 6th, 2012) that found little evidence that these supplements provided any weight loss for those that took them.
This is just to inform you of new treatments available for weight loss. The best advice comes from your own healthcare team. Every medication has a place; it just needs to be used for the right patient for the right reason.