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Bruno Halpern, Marcio C Mancini
Few studies on combination therapies for the treatment of obesity had been conducted until recently, when two fixed-dose combinations, bupropion-naltrexone ER fixed-dose combination and phentermine-topiramate ER titrated-dose combinations were evaluated in clinical studies that ultimately led to FDA approval. Areas covered: In this review, we discuss safety concerns about both combinations, the rationale and history of combination therapies for obesity (including phentermine plus fenfluramine), and possible future new combinations...
October 12, 2016: Expert Opinion on Drug Safety
Candida J Rebello, Frank L Greenway
The homeostatic controls over eating are inextricably linked to the reward aspects of eating. The result is an integrated response that coordinates the internal milieu with the prevailing environment. Thus, appetite, which reflects a complex interaction among the external environment, behavioral profile, and subjective states as well as the storage and metabolism of energy, has an important role in the regulation of energy balance. In the prevailing food environment which offers an abundance of food choices it is likely that the motivation to consume from a wide range of delectable foods plays a greater role in contributing to overeating than in the past when the motivation to eat was largely governed by metabolic need...
October 7, 2016: Advances in Therapy
Christina P Moldovan, Abby J Weldon, Noha S Daher, Louise E Schneider, Denise L Bellinger, Lee S Berk, Alyson C Hermé, Adam L Aréchiga, Willie L Davis, Warren R Peters
OBJECTIVE: To examine the effects of phentermine combined with a meal replacement program on weight loss and food cravings and to investigate the relationship between food cravings and weight loss. METHODS: In a 12-week randomized, double-blind, placebo-controlled clinical trial, 77 adults with obesity received either phentermine or placebo. All participants were provided Medifast(®) meal replacements, were instructed to follow the Take Shape for Life(®) Optimal Weight 5&1 Plan for weight loss, and received lifestyle coaching in the Habits of Health program...
September 24, 2016: Obesity
Michael Erlandson, Laurie C Ivey, Katie Seikel
Obesity is a common condition that is associated with numerous medical problems such as cardiovascular disease, pulmonary disease, and diabetes mellitus. Primary care physicians have an important role in helping patients develop a successful weight loss plan to improve their overall health. Dietary strategies emphasizing reduced caloric intake, regardless of the nutrient composition, are important for weight loss. Behavioral interventions such as motivational interviewing and encouraging physical activity lead to additional weight loss when combined with dietary changes...
September 1, 2016: American Family Physician
Catherine E Thomas, Elizabeth A Mauer, Alpana P Shukla, Samrat Rathi, Louis J Aronne
OBJECTIVE: To characterize the adoption of antiobesity pharmacotherapies, as compared with that of the newest antidiabetes pharmacotherapy, subtype 2 sodium-glucose transport protein inhibitors (SGLT2s), among prescribers in the United States. METHODS: A retrospective analysis of 2012 to 2015 data extracted from the IMS Health National Prescription Audit™ and Xponent™ assessed adoption rates of antiobesity pharmacotherapies and SGLT2s. RESULTS: The number of dispensed antidiabetes prescriptions was 15 times the number of dispensed antiobesity prescriptions...
September 2016: Obesity
Ken Fujioka, Jill Braverman-Panza
The recent approval of liraglutide, lorcaserin, naltrexone/bupropion extended-release, and phentermine/topiramate extended-release, brings the number of medications for long-term weight loss to 5 (including orlistat). Indicated for the treatment of patients with overweight (body mass index [BMI] ≥27 kg/m2 with ≥1 weight-related comorbidity) or obesity (BMI ≥30 kg/m2), these medications provide new opportunities to address this burgeoning health problem.
July 2016: Journal of Family Practice
Matthew H Vorsanger, Pritha Subramanyam, Howard S Weintraub, Steven H Lamm, James A Underberg, Eugenia Gianos, Ira J Goldberg, Arthur Z Schwartzbard
The global obesity epidemic and its impact on cardiovascular outcomes is a topic of ongoing debate and investigation in the cardiology community. It is well known that obesity is associated with multiple cardiovascular risk factors. Although life-style changes are the first line of therapy, they are often insufficient in achieving weight loss goals. Liraglutide, naltrexone/bupropion, and phentermine/topiramate are new agents that have been recently approved to treat obesity, but their effects on cardiovascular risk factors and outcomes are not well described...
August 23, 2016: Journal of the American College of Cardiology
Yun Jeong Choi, Arum Sim, Min Kyung Kim, Sunglll Suh, Moon Kyo In, Jin Young Kim
Nonmedical use of prescription stimulants such as phentermine (PT) has been regulated by law enforcement authorities due to its euphorigenic and relaxing effects. Due to high potential for its abuse, reliable analytical methods were required to detect and identify PT and its metabolite in biological samples. Thus a dilute and shoot liquid chromatography-tandem mass spectrometric (LC-MS/MS) method was developed and validated for simultaneous determination of PT, N-hydroxyphentermine (NHOPT) and mephentermine (MPT) in urine...
September 1, 2016: Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences
Ziad Omran
Obesity is growing at an alarming rate with huge consequences on health and economy. The worldwide prevalence of obesity has nearly doubled in 30 years. Obesity causes many physiological dysfunctions that affect nearly every organ producing multiple morbidities. Despite these facts, there is still no clear, well-defined solution. Notwithstanding the devastating prevalence and consequences of obesity, today only five medicines, orlistat, lorcaserin, phentermine-toprimate, bupropion-naltrexone and liraglutide, are approved by the FDA for long-term treatment of obesity...
June 16, 2016: Mini Reviews in Medicinal Chemistry
Rohan Khera, Mohammad Hassan Murad, Apoorva K Chandar, Parambir S Dulai, Zhen Wang, Larry J Prokop, Rohit Loomba, Michael Camilleri, Siddharth Singh
IMPORTANCE: Five medications have been approved for the management of obesity, but data on comparative effectiveness are limited. OBJECTIVE: To compare weight loss and adverse events among drug treatments for obesity using a systematic review and network meta-analysis. DATA SOURCES: MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Central from inception to March 23, 2016; clinical trial registries. STUDY SELECTION: Randomized clinical trials conducted among overweight and obese adults treated with US Food and Drug Administration-approved long-term weight loss agents (orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, or liraglutide) for at least 1 year compared with another active agent or placebo...
June 14, 2016: JAMA: the Journal of the American Medical Association
Nele Plock, Leon Bax, Douglas Lee, Deborah DeManno, Gezim Lahu, Marc Pfister
The presented analysis was performed to characterize the relationship between treatment-related early (week 4) and longer-term (3-6 months) weight loss to understand the potential utility of 4-week proof-of-mechanism studies in the early decision-making process during clinical development of new anti-obesity compounds. A regression-based meta-analysis was performed leveraging publically available clinical outcomes data to (i) characterize the within-trial relationship between treatment-related early and longer-term body weight loss, (ii) identify and quantify key covariate effects on this relationship...
June 9, 2016: Journal of Clinical Pharmacology
Ruth Verplaetse, Jack Henion
A workflow overcoming microsample collection issues and hematocrit (HCT)-related bias would facilitate more widespread use of dried blood spots (DBS). This report describes comparative results between the use of a pipet and a microfluidic-based sampling device for the creation of volumetric DBS. Both approaches were successfully coupled to HCT-independent, fully automated sample preparation and online liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) analysis allowing detection of five stimulants in finger prick blood...
July 5, 2016: Analytical Chemistry
Prabin Sharma, Parasuram Krishnamoorthy
Weight-loss medications have been associated with many conditions, including valvular heart disease, ischemic colitis, and pulmonary hypertension. There is a constant increase in the use of these drugs, especially new medications with better efficacy. Phentermine is one such drug, approved for short-term use to lose weight. We report a case of ischemic colitis in a female patient linked to inappropriate phentermine intake. The patient presented with symptoms of severe abdominal pain and repeated bowel movement associated with rectal bleeding for two weeks...
April 2016: Connecticut Medicine
Maite Solas, Fermin I Milagro, Diego Martínez-Urbistondo, Maria J Ramirez, J Alfredo Martínez
Five pharmaceutical strategies are currently approved by the US FDA for the treatment of obesity: orlistat, lorcaserin, liraglutide, phentermine/topiramate, and bupropion/naltrexone. The most effective treatment seems to be the combined administration of phentermine/topiramate followed by lorcaserin and bupropion/naltrexone. In relation to the management of excessive weight, other aspects also need to be considered, including comorbidities accompanying obesity, drug interactions, and the risk of negative collateral effects, as well as individualized treatments based on the genetic make-up...
July 2016: Trends in Pharmacological Sciences
Alison S Poulton, Emily J Hibbert, Bernard L Champion, Ralph K H Nanan
The focus of this paper is treatment of obesity in relation to the management of hedonic appetite. Obesity is a complex condition which may be potentiated by excessive reward seeking in combination with executive functioning deficits that impair cognitive control of behavior. Stimulant medications address both reward deficiency and enhance motivation, as well as suppressing appetite. They have long been recognized to be effective for treating obesity. However, stimulants can be abused for their euphoric effect...
2016: Frontiers in Pharmacology
Katherine H Saunders, Rekha B Kumar, Leon I Igel, Louis J Aronne
Obesity is a growing epidemic in the USA with over one third of adults presently classified as obese. Obesity-related comorbidities include many leading causes of preventable death such as heart disease, stroke, type 2 diabetes, and certain types of cancer. Modest weight loss of 5-10 % of body weight is sufficient to produce clinically relevant improvements in cardiovascular disease risk factors among patients with overweight and obesity. Until recently, there were limited pharmacologic options approved by the Food and Drug Administration to treat obesity...
July 2016: Current Atherosclerosis Reports
Andrew K Capulli, Luke A MacQueen, Blakely B O'Connor, Stephanie Dauth, Kevin Kit Parker
Medications based on ergoline-derived dopamine and serotonin agonists are associated with off-target toxicities that include valvular heart disease (VHD). Reports of drug-induced VHD resulted in the withdrawal of appetite suppressants containing fenfluramine and phentermine from the US market in 1997 and pergolide, a Parkinson's disease medication, in 2007. Recent evidence suggests that serotonin receptor activity affected by these medications modulates cardiac valve interstitial cell activation and subsequent valvular remodeling, which can lead to cardiac valve fibrosis and dysfunction similar to that seen in carcinoid heart disease...
July 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Jeffrey S MacDaniels, Thomas L Schwartz
OBJECTIVE: Comparison of the efficacy and tolerability of five newer anti-obesity medications to guide clinical decision making, examining bupropion-naltrexone combination, liraglutide, lorcaserin, orlistat, and phentermine-topiramate combination. METHODS: A brief literature review and internet search for high-powered, randomized and placebo-controlled drug trials was conducted. Drug trial information was established for five currently approved anti-obesity medications...
2016: Drugs in Context
Mafalda Castro, Marco Preto, Vitor Vasconcelos, Ralph Urbatzka
Obesity is a global health threat. OECD reported that more than half (52%) of the adult population in the European Union is overweight or obese. Obesity and obesity-related co-morbidities have deep negative effects on morbidity, mortality, professional and personal quality of life. Healthcare costs represent a negative impact of this disease, with an associated economic cost of 100 billion US$ per year in the United States. The most prescribed drugs for obesity treatment worldwide are orlistat, and phentermine/topiramate extended release, while the major prescribed drug for the same disease in the US are exenatide and dapagliflozin...
2016: Current Topics in Medicinal Chemistry
Yue Chen
As the most significant cause of death worldwide, obesity has become one of the world's most important public health problems, but approved anti-obesity drugs are extremely limited. This article summarizes the feeding control circuits and regulators involved in obesity development, highlight the hypothalamus, melanocortin system and brain-gut peptide actions in this process, and the five US FDA approved anti-obesity medications in long term use, namely phentermine/topiramate, lorcaserin, naltrexone/bupropion, liraglutide and orlistat...
2016: Drug Discoveries & Therapeutics
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