WEIGHT LOSS DRUGS & DIET PLAN SUPPLEMENTS

Prescription Weight Loss Drugs

Obesity often requires long-term treatment to promote and sustain weight loss. As in other chronic conditions, such as diabetes or high blood pressure, use of prescription drugs may be appropriate for some people. While most side effects of prescription weight loss drugs are mild, serious complications have been reported. More on that below.

Keep in mind that these drugs are not a cure-all for obesity. The use of weight loss drugs should be combined with physical activity and improved diet to lose and maintain weight successfully over the long term.

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Do I Need a Prescription Weight Loss Drug?

Using prescription weight loss drugs to treat obesity should be used as an option for the following individuals:

• People with a body mass index(BMI) of 30 and above with no obesity-related conditions.
• A person with a BMI of 27 and above with obesity-related conditions, such as diabetes or high blood pressure.

Types of Prescription Weight Loss Drugs

Currently, most available weight loss drugs approved by the FDA are for short-term use, meaning a few weeks or months.

One type of weight-loss medication is "appetite suppressants." These drugs generally come in the form of tablets or extended-release capsules (pills that release medication over a long period of time). Appetite suppressants can be obtained by a doctor's prescription or purchased over the counter. One common prescription appetite suppressant is phentermine.

The drug Qsymia combines phentermine with the seizure /migraine drug topiramate . Topiramate causes weight loss in several ways, including increasing feelings of fullness, making foods taste less appealing, and increasing calorie burning. Qsymia is designed to be taken long term. However, it cannot be taken by pregnant women and will only be sold through certified pharmacies. 

 

Another type of prescription weight loss drug is a fat absorption inhibitor. Xenical is the only example of this type of treatment approved for use in the U.S. Xenical works by blocking about 30% of dietary fat from being absorbed. Xenical is now sold over-the-counter as Alli.

Xenical is the only weight loss drug approved for longer-term use in significantly obese people, although the safety and effectiveness have not been established for use beyond two years.

Newer drugs are being studied as potential treatments for obesity, some of which are showing promise and may be available in the near future.

How Do Appetite Suppressants Cause Weight Loss?

Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry or that it is full. They decrease appetite by increasing serotonin or catecholamine -- two brain chemicals that affect mood and appetite.

How Do Fat Absorption Inhibitors Cause Weight Loss?

Fat absorption inhibitors work by preventing your body from breaking down and absorbing fat eaten with your meals. This unabsorbed fat is eliminated in bowel movements.

Does Xenical Really Work?

In general, Xenical is moderately effective, leading to an average weight loss of 12 to 13 pounds over a one-year period, more than what would be expected with non-drug treatments. Most of the weight loss is generally experienced in the first 6 months. 

Over the short term, weight loss from prescription drugs may reduce a number of health risks in obese people. However, there are currently no studies to determine the effects of these medications over the long term.

The Risks of Prescription Weight Loss Drugs

When considering long-term weight loss drugs for obesity, the following possible concerns and risks should be discussed with your doctor:

• Addiction . Currently, all prescription obesity drugs except Xenical are "controlled substances." This means that doctors are required to follow certain restrictions when prescribing them since they could be addictive.
• Developed tolerance. Most people's weight tends to level off after six months while taking a weight-loss medication. This leads to a concern that the person has developed a tolerance for the medication. However, it is unclear whether this leveling off is indeed due to a developed tolerance or if the drug has reached its limit in effectiveness.
• Side effects. Most side effects of weight loss drugs are mild (although some can be unpleasant) and usually improve as your body adjusts to the medication. Rarely, serious and even fatal outcomes have been reported.
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The Side Effects of Prescription Weight Loss Drugs

Most appetite suppressants are used as a short-term treatment for obese people. Not only do the drugs' effects tend to wear off after a few weeks, but they can also have some unpleasant side effects, including:

• Increased heart rate
• Increased blood pressure
• Sweating
• Constipation
• Insomnia (inability to sleep or stay asleep)
• Excessive thirst
• Lightheadedness
• Drowsiness
• Stuffy nose
• Headache
• Anxiety
• Dry mouth

Some side effects with Xenical include abdominal cramping, passing gas, leakage of oily stool, increased number of bowel movements, and the inability to control bowel movements. These side effects are generally mild and temporary, but may be worsened by eating foods that are high in fat. Patients should eat a low-fat diet (less than 30% of calories from fat) before starting treatment with Xenical. Because Xenical reduces the absorption of some vitamins, people taking Xenical should take a multivitamin at least two hours before or after taking the medication.

Because these drugs are not recommended for long-term use, it is important for people who are trying to lose weight to learn new eating habits and to exercise while the drug is still effective. Once healthy eating and regular exercise have been learned and established, it is important to continue eating right and exercising if you hope to continue losing weight and keep lost weight from returning.

With Qsymia, women who might become pregnant are advised to use effective birth control while on the drug, and monthly pregnancy tests are also being recommended, along with an initial negative pregnancy test before starting the medication. Fetal exposure to topiramate has been linked to an increased risk for cleft lip, with or without cleft palate.
Qsymia also must not be used in people with glaucoma or hyperthyroidism . And it's not recommended for people with recent or unstable heart disease or stroke. Patients are recommended to have regular monitoring of heart rate when starting the drug or increasing the dose.

Weight loss drugs are not for everybody. For example, there are limited studies on these medications' effects on older adults and on children.

Discussing Prescription Weight Loss Drugs With Your Doctor

Before a doctor will prescribe a prescription weight loss drug, he or she will ask you about the following: any existing allergies you may have, whether or not you are pregnant or breastfeeding, and what types of other drugs you may be taking. Existing medical conditions may also affect the use of these drugs. You should tell your doctor if you have any of the following conditions:

• Diabetes
• High blood pressure
• Heart disease
• Epilepsy (seizures)
• Kidney disease
• Glaucoma
• Alcohol or drug abuse (or a history of)
• Overactive thyroid (hyperthyroidism)
• Depression or other mental illness
• Migraine headaches requiring medication
• Planning to have surgery requiring general anesthesia
• Pregnancy or planning to become pregnant
• Breastfeeding

People who are prescribed appetite suppressants should follow the prescription carefully. Because appetite suppressants may cause drowsiness or lightheadedness, it is important to know how you respond to these medications before you attempt to drive or operate machinery.

Further Reading:

• Weight Loss With Medication 
• Supplements and Herbal Remedies for Weight Loss
• All About Alli, the Weight Loss Pill
• Beware Untested Diet Pills
• Weight Loss Drug Meridia Off the Market at FDA's Request
• The Truth About Weight-Loss Pills
• Safe Use of Dietary Supplements
• See All Diet Pills Topics

FDA Rejects Weight Loss Drug Meridia

Meridia Withdrawn From Market; FDA Cites Risk to Heart

By Daniel J. DeNoon
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 8, 2010 -- At the FDA's request, Abbott Laboratories is withdrawing the weight loss drug Meridia from the market.
The FDA says the drug, approved in 1997, raises the risk of heart attack and stroke but offers little benefit.
In September, an FDA expert advisory panel split in an 8-8 vote over whether the drug should be allowed to stay on the market.
"Meridia's continued availability is not justified when you compare the very modest weight loss that people achieve on this drug to their risk of heart attack or stroke," said John Jenkins, MD, director of FDA's drug evaluation branch.
The estimated 100,000 U.S. patients taking Meridia are advised to discard any remaining pills in their possession and to consult their doctors about alternative weight loss plans.
Abbott strongly disagrees with the FDA's evaluation of Meridia but says it will comply with the federal agency's request.
"Abbott believes [Meridia] has a positive risk/benefit profile in the approved patient population, but will comply with the FDA's request," the company says in a news release.
 

Risk of Heart Attack, Stroke

Concerns about Meridia risks were raised at the time the drug was considered for approval. At that time, the drug was shown to increase heart rate and blood pressure. But since weight loss was supposed to reduce this risk, it was thought that the drug's benefit would more than make up for the risk.
However, European drug regulators insisted that Abbott carry out a postmarketing clinical trial to evaluate heart risk. The trial, called SCOUT, enrolled overweight and obese patients with risk factors for serious heart disease. Most of these patients would not be prescribed Meridia in the U.S. But Abbott expected the study to show that even these patients benefited from the drug.
Instead, Meridia slightly increased the SCOUT patients' risk of heart attack and stroke.
"The fact that it showed no benefit but actually harm was important new information," Jenkins said at a news teleconference. "When we started reviewing that data, we realized that all patients using this drug are at risk of those events, even though the risk in any individual patient might be very small."
Here's the FDA's full advice to patients now taking Meridia:

• Stop taking Meridia and talk to your health care professional about alternative weight loss and weight loss management programs.
• Talk to your health care professional if you have any concerns about Meridia.
• Contact your health care professional right away if you experience pain in the chest, heart palpitations, abnormal heart rate or rhythm, or other symptoms including dizziness and lightheadedness.
• Dispose of unused Meridia in your household trash by following the recommendations outlined in the Federal Drug Disposal Guidelines:
  • Take your Meridia out of its original container and mix it with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets and unrecognizable to people who may intentionally go through your trash.
  • Put the medication in a sealable bag, empty can, or other container to prevent it from breaking out of a garbage bag.
• Report any side effects from Meridia to the FDA's MedWatch program using the information at the bottom of the page in the "Contact Us" box.
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• Drug Found in 'Supplements'

  Unapproved drugs, often sold as supplements, are frequently found to contain various amounts of sibutramine, the active ingredient in Meridia.
  Coincidentally, the FDA today warned that a "supplement" called Slimming Beauty Bitter Orange Slimming Capsules contains dangerous amounts of sibutramine. The product is sold over the Internet by Beautiful Health Inc., formerly LL Health and Beauty.
  The label falsely says the product is "100% herbal." The mislabeled drug was distributed in Chicago at the Mexican Independence Day parade and may be distributed at other community events.
  People taking the pills can experience anxiety, nausea, heart palpitations, a racing heart, insomnia, and elevated blood pressure. It may be very dangerous to people with underlying heart conditions.
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  Dietary Supplements (Herbal Medicines and Natural Products) - Topic Overview

  
  

  What are dietary supplements?

  In the United States, dietary supplements are substances you eat or drink. They can be vitamins, minerals, herbs or other plants, amino acids (the individual building blocks of protein), or parts of these substances. They can be in pill, capsule, tablet, or liquid form. They supplement (add to) the diet and should not be considered a substitute for food.
  Dietary supplements are widely available in the United States in health food stores, grocery stores, pharmacies, on the Internet, and by mail. People commonly take them for health-related reasons. Common dietary supplements include vitamins and minerals (such as vitamin C or a multivitamin), botanicals (herbs and plant products, such as St. John's wort), and substances that come from a natural source (such as omega-3 fatty acids).
  Makers of dietary supplements cannot legally say that dietary supplements can diagnose, cure, treat, or prevent disease. But they can say that they contribute to health maintenance and well-being.
  People have used the active ingredients in dietary supplements for thousands of years to help health and to treat illness. Sometimes those supplements are the basis for some of today's common medicines. For example, people have used willow bark tea for centuries to control fever. Pharmaceutical companies eventually identified the chemical in willow bark that reduces fever and used that knowledge to produce aspirin.
  The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the same way that it regulates medicine. A dietary supplement can be sold without research on how well it works.
  
  

  Dietary Supplements (Herbal Medicines and Natural Products) - Topic Overview

  
  

  What are dietary supplements?

  In the United States, dietary supplements are substances you eat or drink. They can be vitamins, minerals, herbs or other plants, amino acids (the individual building blocks of protein), or parts of these substances. They can be in pill, capsule, tablet, or liquid form. They supplement (add to) the diet and should not be considered a substitute for food.
  Dietary supplements are widely available in the United States in health food stores, grocery stores, pharmacies, on the Internet, and by mail. People commonly take them for health-related reasons. Common dietary supplements include vitamins and minerals (such as vitamin C or a multivitamin), botanicals (herbs and plant products, such as St. John's wort), and substances that come from a natural source (such as omega-3 fatty acids).
  Makers of dietary supplements cannot legally say that dietary supplements can diagnose, cure, treat, or prevent disease. But they can say that they contribute to health maintenance and well-being.
  People have used the active ingredients in dietary supplements for thousands of years to help health and to treat illness. Sometimes those supplements are the basis for some of today's common medicines. For example, people have used willow bark tea for centuries to control fever. Pharmaceutical companies eventually identified the chemical in willow bark that reduces fever and used that knowledge to produce aspirin.
  The U.S. Food and Drug Administration (FDA) does not regulate dietary supplements in the same way that it regulates medicine. A dietary supplement can be sold without research on how well it works.
  

  What are dietary supplements used for?

  People use dietary supplements for many health conditions.
  

  
  

  • People often use vitamins and minerals to supplement diet and treat disease. For example, echinacea may keep you from getting a cold and may help you get better faster.¹ High doses of vitamin C may also help you get better faster.
  • 
  • Historically, people have used herbal medicines to prevent illness, cure infection, reduce fever, and heal wounds. Herbal medicines can also treat constipation, ease pain, or act as relaxants or stimulants. Research on some herbs and plant products has shown that they may have some of the same effects that conventional medicines do, while others may have no effect or may be harmful.
  • Researchers have studied some natural products and have found them to be useful. Omega-3 fatty acids, for example, may help lower triglyceride levels.
  • 
    

  

  Are dietary supplements safe?

  Not all herbs and supplements are safe. If you are unsure about the safety of a supplement or herb, talk to your doctor, pharmacist, or dietitian.
  Always tell your doctor if you are using a dietary supplement or if you are thinking about combining a dietary supplement with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on a dietary supplement. This is especially important for women who are pregnant or breast-feeding.
  When using dietary supplements, keep in mind the following.
  

  • Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse.
  • The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
  • Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.

  WebMD Medical Reference from Healthwise
  

  Last Updated: June 30, 2009

  This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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