Side effects continue to limit the utility of pharmacologic treatments for obesity, Dr. Jonathan Purnell said at a meeting on drug therapy sponsored by the University of Washington.
Potential side effects of therapy with phentermine or sibutramine include primary pulmonary hypertension (associated with phentermine), dry mouth, constipation, insomnia, anxiety; increased blood pressure, and palpitations and increased heart rate.
Phentermine works to release dopamine and norepinephrine, while sibutramine facilitates serotonin and norepinephrine release. The range of weight loss ascribed to these medications is 2-10 kg, said Dr. Purnell of Harborview Medical Center in Seattle.
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Orlistat contains a nonabsorbed inhibitor of gastric and pancreatic lipase. This results in reduced absorption of fat and fat-soluble substances.
The range of weight loss ascribed to this medication is 5-7.5 kg when combined with a hypocaloric diet.
After prescribing a weight-loss medication, Dr. Purnell sees patients 1 month later to assess tolerability and then every 3-4 months to check for side effects and assess the impact of regular aerobic exercise and other lifestyle measures. He discontinues medical therapy if patients have significant side effects or have lost less than 5%-10% of body weight after 6 months of drug therapy.