Endocrinology Book

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Obesity Medication

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  1. Indications (Follow these strictly!!)
    1. Morbid Obesity (BMI>30)
    2. Moderate Obesity (BMI 27) with comorbidity
  2. Medications (most are DEA Controlled agents)
    1. FDA Schedule 4 Medications
      1. Phentermine (Fastin, Adipex-P, Lonamin)
      2. Diethylpropion (Tenuate)
      3. Sibutramine (Meridia)
    2. FDA Schedule 3 Medications
      1. Benzphetamine (Didrex)
      2. Phendimetrazine (Bontril)
    3. Non-FDA-Scheduled medications
      1. Orlistat (Xenical)
  3. Combination Protocols: Phentermine and Prozac
    1. Phentermine 30 mg PO qd
    2. Prozac 20 mg PO qd
  4. Dietary Supplements
    1. See Dietary Supplements in Obesity
  5. Contraindications (does not include Orlistat)
    1. Noradrenergic agents (all agents other than Orlistat)
      1. Hypertension
      2. Advanced cardiovascular disease
        1. Coronary Artery Disease
        2. Congestive Heart Failure
        3. Arrhythmias
      3. Hyperthyroidism
      4. Narrow-Angle Glaucoma
      5. Substance Abuse history
    2. Sibutramine (Mixed Noradrenergic-Serotonergic Agent)
      1. Includes Noradrenergic contraindications above
      2. Severe renal insufficiency
      3. Hepatic insufficiency
      4. Cerebrovascular Accident
  6. Drug Interactions
    1. Orlistat interferes only with Cyclosporine
    2. Noradrenergic agents (all except Orlistat)
      1. MAO inhibitors
      2. Guanethidine
      3. Tricyclic Antidepressants
      4. Alcohol
      5. Centrally acting stimulants or anorexiants
    3. Sibutramine (Mixed Noradrenergic-Serotonergic Agent)
      1. Includes Noradrenergic drug interactions above
      2. SSRI
      3. Triptans (for Migraine Headache Management)
      4. Dihydroergotamine (DHE)
      5. Dextromethorphan
      6. Meperidine
      7. Pentazocine
      8. Fentanyl
      9. Lithium
  7. Adjunctive Therapies
    1. Ursodeoxycholic Acid 600mg qd
      1. Prevention of Gallstones in dieting obese patients
      2. Reference
        1. Shiffman (1995) Ann Intern Med 122:899
  8. Pharmacologic Therapies recalled by FDA for CV effects
    1. Fenfluramine
    2. Dexfenfluramine
    3. Phenylpropanolamine (over-the-counter)
      1. Decongestant that stimulates Adrenergic Receptors
      2. Elevates Blood Pressure
  9. Research Drugs (not approved)
    1. Selective Cannabinoid Type I Blocker
      1. Acomplia (Rimonabant) is first in class
      2. Decreases appetite by blocking cannabinoid receptors
      3. May also be effective in Tobacco Cessation
      4. Fernandez (2004) Curr Opin Investig Drugs 5:430
    2. Growth Hormone
      1. No change in body weight
      2. Decreases Body fat 9.2%
      3. Decreased visceral fat 18%
      4. Johanssen (1997) J Clin Endocrinol Metab 82:727
  10. References
    1. (1998) AOA Treatment Adult Obesity, 2nd edition
    2. Frank (1998) J Am Diet Assoc 98:S44
    3. Lyznicki (2001) Am Fam Physician 63(11):2185
    4. Rippe (1998) J Am Diet Assoc 98:S9
    5. Speer (1997) Phys Sportsmed 25:94
    6. Yanovski (2002) N Engl J Med 346:593

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