Sibutramine (Meridia)
Sibutramine (Meridia) helps balance the brain chemicals, serotonin and norepinephrine. This helps increase metabolism. It causes a feeling of fullness and increases energy levels. It may be particularly useful for binge-eaters. Studies indicate that sibutramine is effective in achieving weight loss, although it slows considerably after the first 3 months. The agent also appears to improve cholesterol and lipid levels and have other effects that may benefit the heart.
Side effects are common. They include dry mouth, constipation, and insomnia, and in one study almost half the patients dropped out because of them. There have been reports of increases in heart rate and blood pressure, although a 2001 study indicates that blood pressure stabilize over time. At this time, people who have a history of high blood pressure, stroke, heart disease, or arrhythmias should not take this drug. People taking decongestants, bronchodilators (such as for asthma), monoamine oxidase inhibitors, or serotonin reuptake inhibitors should also avoid sibutramine.
Psychostimulants
Phentermine and Other Sympathomimetics. Sympathomimetics are agents that act like the neurotransmitter norepinephrine (a stress hormone) and act as stimulants in the brain. Some are approved for treating obesity, but only for short-term use. They include:
- Phentermine (Ionamin, Adipex, Fastin)
- Benzphetamine (Didrex)
- Phendimetrazine (Adipost, Bontril, Melfiat, Plegine, Prelu-2, Statobex)
Phentermine is the most commonly prescribed appetite suppressant and is less expensive than orlistat or sibutramine. Its effects are not long lasting, however. They can also raise blood pressure. In addition, such drugs are associated with depression, which is already a problem in many cases of obesity. A combination (Phen-Pro) containing phentermine and the antidepressant fluoxetine (Prozac) is being investigated to help reduce this problem. Note: Neither phentermine nor such combinations are associated with the heart problems linked to the previous phentermine combination with fenfluramine (Fen-Phen).
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