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Slimming productsSlimming drugs (anti-obesity drugs) are active ingredients for the treatment of overweight and obesity. The drugs are intended to reduce or maintain body weight and reduce associated health risks.
synonymous: anorectics, appetite suppressants, slimming productsEffects
Anti-obesity drugs differ in their effects. They inhibit appetite or increase satiety, reduce the uptake of food components in the intestine or promote their utilization, increase energy expenditure and breakdown metabolic processes.
The ideal slimming product would enable rapid, high and stable weight loss and at the same time be very well tolerated and applicable to all patient groups. Unfortunately, such a miracle cure is not yet on the market.Indications
For the treatment of overweight and obesity (obesity). Treatment should always be accompanied by a change in diet and increased physical activity.1. Approved active ingredients
- Orlistat (Xenical®, generics, OTC preparations) is an active ingredient from the group of lipase inhibitors that is used to treat overweight and obesity (BMI ≥ 28). It inhibits the digestion of fats in the intestines that are not absorbed but are excreted in the stool. Orlistat can be taken before, during, or up to 1 hour after eating. The meals should only contain a small amount of fat, otherwise undesirable effects such as fatty stools, diarrhea and abdominal pain can occur. Isolated cases of liver disease during treatment have been reported.
GLP-1 receptor agonists:
- The antidiapetic liraglutide (Saxenda®) was approved in 2016 for the treatment of overweight and obesity → see under liraglutide
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRI):
- Sibutramine (Reductil®, except for trade) has an appetite-suppressing effect, increases the feeling of satiety and possibly increases thermogenesis. The effectiveness has been proven in numerous clinical studies and is based on an inhibition of the reuptake of norepinephrine and serotonin. It was approved as an additional measure in obesity (BMI ≥ 30). During treatment, the numerous contraindications, interactions and undesirable effects had to be taken into account. Sibutramine often leads to undesirable effects such as palpitations, increased blood pressure, constipation, dry mouth, vasodilation, headaches and insomnia. It could only be administered under medical supervision. Sibutramine was withdrawn from the market in Switzerland at the end of March 2010. Other active ingredients from the SSNRI group such as the antidepressants venlafaxine (Efexor®, generics) and duloxetine (Cymbalta®) are also appetite suppressants, but are not approved for this indication.
Cannabinoid Receptor Antagonists:
- Rimonabant (Acomplia®, out of trade). Cannabinoid receptor antagonists neutralize the effects of the endocannabinoid system, which is physiologically activated by the endogenous ligand anandamide and the intoxicant cannabis. The effects are largely opposite to those of cannabis. Cannabinoid receptor antagonists have an appetite-suppressing, anti-obesity and lipid-lowering effect and are used to treat overweight and obesity. Common adverse effects are psychiatric disorders such as depressive moods. The only representative of the drug group to date is rimonabant (Acomplia®, Sanofi-Aventis) and was withdrawn from the market shortly after its introduction in 2008 due to the poor risk-benefit ratio.
Many other drugs can reduce body weight, but are not approved in Switzerland for the indications of overweight and obesity. Their weight-reducing effect can be useful in the approved indication, for example in diabetes mellitus or depression with simultaneous obesity. Due to the undesirable effects, however, it is questionable whether they should be prescribed off-label for medical treatment for the exclusive treatment of obesity.
Sympathomimetics, amphetamines and amphetamines like:
Norepinephrine and dopamine reuptake inhibitors:
- Bupropion (Zyban®, Wellbutrin®) is approved for the treatment of depression and for smoking cessation. It increases the feeling of satiety and seems moderately effective.
Serotonin reuptake inhibitors:
- Fluoxetine (Fluctine®, generic) is prescribed off-label and is appetite suppressant. The clinical effectiveness, especially with regard to long-term weight loss, is controversial.
- Fenfluramine has a direct and indirect serotonergic effect. It was considered to be very effective, especially in combination with phentermine ("Fen-Phen"), but was withdrawn from the market due to undesirable effects (pulmonary hypertension, heart valve disorders). See also under Benfluorex.
- Sertraline (Zoloft®, generics)
- The thyroid hormones levothyroxine and liothyronine have been used as slimming products since the 19th century. They promote fat loss and increase the basal metabolic rate. The numerous undesirable effects are problematic.
- Betahistine has an appetite suppressant and could be used as an anti-obesity in the future.
- Dipeptidyl peptidase-4 inhibitors such as vildagliptin (Galvus®) and sitagliptin (Januvia®) inhibit the breakdown of incretins and thus promote their effects.
- Metformin (Glucophage®, generics) has an anti-obesity effect, which is desirable in diabetics (type 2), as they are often overweight.
- Other antidiabetic drugs are more likely to lead to weight gain.
Newer anti-epileptic drugs:
- Topiramat (Topamax®) is approved for the treatment of epilepsy and for migraine prophylaxis and has an appetite suppressant effect. The effectiveness as an anti-obesity has been proven, but is limited by frequently occurring undesirable effects such as drowsiness, fatigue, paresthesia, headache, dizziness and nausea. The same applies to zonisamide (Zonegran®)
- Naltrexone (Naltrexin®) inhibits food intake. It is approved for drug support in the treatment of withdrawal from previously opiate addicts. Loss of appetite is a common undesirable effect. Naltrexone is also used off-label for other addictions. A combination with bupropion is approved in the USA, see under naltrexone bupropion (Contrave®).
Since many drugs have anti-obesity effects but are not approved for this indication, some patients misuse them for weight loss. This applies to thyroid hormones or sympathomimetics such as ephedrine and phenylpropanolamine, which are available as veterinary drugs. The possible abuse must be considered in the pharmacy, since the uncontrolled consumption of such agents can lead to serious undesirable effects, especially through interactions and contraindications.
Another problem are slimming products sold on the Internet that contain potent active ingredients. Swissmedic recently issued a warning against the slimming product Zhen de Shou, which is sold on the Internet and contains sibutramine.4. Alternative anti-obesity drugs
Numerous herbal and other alternative medicinal products are available as drugs, medical devices or food supplements. As a rule, the effectiveness of these agents has not been reliably proven. Herbal products such as caffeine, tobacco (smoking), ephedra or herbal laxatives can also lead to undesirable effects.
Dietary fiber and dietary fiber:
- Konjac flour (konjac plant, glucomannan), guar (guar galactomannan), Jerusalem artichoke, fleas and Indian fleas are said to have a satiating effect by swelling with water and to inhibit the absorption of fats. They should be taken with sufficient water.
- Chitosan is a ß-1,4-polymer made of D-glucosamine and N-acetyl-D-glucosamine from crustacean shell, according to the manufacturer it binds fats in the food and thus prevents them from being absorbed by the organism. For detailed information, see the article Chitosan.
Caffeine and Caffeine Drugs:
- Ephedra and its ingredient ephedrine inhibit appetite and promote thermogenesis. They appear to be effective to a limited extent, are not approved for this indication in Switzerland and can lead to serious adverse effects (cardiovascular system). The combination with caffeine is common.
- PhaseLite, herbal diuretics and laxatives, algae, spirulina, ginseng, chromium, Hoodia gordonii, Garcinia cambogia, licorice, L-carnitine, dandelion, St. John's wort, vitamin B5, apple cider vinegar and guggul. Guggul is the resin of the balsam tree Commiphora mukul and is used in Ayurvedic medicine against obesity.
- Aronne L.J. et al. When prevention fails: obesity treatment strategies. Am J Med, 2009, 122 (4 Suppl 1), S24-32 Pubmed
- Avenell A., Sattar N., Lean M. ABC of obesity. Management: Part I - behavior change, diet, and activity, BMJ, 2006, 333 (7571), 740-3 Pubmed
- Chiesi M., Huppertz C., Hofbauer K.G. Pharmacotherapy of obesity: targets and perspectives. Trends Pharmacol Sci, 2001, 22 (5), 247-54 Pubmed
- Clapham J.C., Arch J.R., Tadayyon M. Anti-obesity drugs: a critical review of current therapies and future opportunities. Pharmacol Ther, 2001, 89 (1), 81-121 Pubmed
- Colman E. Anorectics on trial: a half century of federal regulation of prescription appetite suppressants. Ann Intern Med, 2005, 143 (5), 380-5 Pubmed
- Cooke D., Bloom S. The obesity pipeline: current strategies in the development of anti-obesity drugs. Nat Rev Drug Discov, 2006, 5 (11), 919-31 Pubmed
- Ioannides-Demos L.L., Proietto J., McNeil J.J. Pharmacotherapy for obesity. Drugs, 2005, 65 (10), 1391-418 Pubmed
- Kinnell H.G. European withdrawal of appetite suppressants. Obes Rev, 2003, 4 (2), 79-81 Pubmed
- Lean M., Finer N. ABC of obesity. Management: part II - drugs. BMJ, 2006, 333 (7572), 794-7 Pubmed
- Luque C.A., Rey J.A. The discovery and status of sibutramine as an anti-obesity drug. Eur J Pharmacol, 2002, 440 (2-3), 119-28 Pubmed
- Rubio M.A. et al. Drugs in the treatment of obesity: sibutramine, orlistat and rimonabant. Public Health Nutr, 2007, 10 (10A), 1200-5 Pubmed
- Saper R.B., Eisenberg D.M., Phillips R.S. Common dietary supplements for weight loss. Am Fam Physician, 2004, 70 (9), 1731-8 Pubmed
- Tankova T. et al. Metformin in the treatment of obesity in subjects with normal glucose tolerance. Rom J Intern Med, 2003, 41 (3), 269-75 Pubmed
- Medicinal Compendium
- Reynolds J. (Ed.) Martindale. The Extra Pharmacopoeia. London: The Pharmaceutical Press, 1989
- Instructions for use Formoline L112 http://www.formoline.ch/
Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.additional Information
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