Drug Treatment of Obesity

被引:66
作者
Bray G.A. [1 ]
机构
[1] Boyd Department, Pennington Biomed. Research Center, Louisiana State University, Baton Rouge, LA 70808
关键词
Ephedrine; Leptin; Monoamine; Orlistat; Peptides; Sibutramine; Thermogenic;
D O I
10.1023/A:1011808701117
中图分类号
学科分类号
摘要
At present only two drugs are approved for long-term treatment of obesity. Sibutramine inhibits the reuptake of serotonin and norepinephrine. In clinical trials it produces a dose-dependent 5-10% decrease in body weight. Its side effects include dry mouth, insomnia, asthenia, and constipation. In addition, sibutramine produces a small increase in blood pressure and pulse that is a contra-indication to the use of this drug in some individuals with heart disease. Xenical is the other drug approved for long-term use in the treatment of obesity. It works by blocking lipase and thus increasing the fecal loss of triglyceride. One valuable consequence of this mechanism of action is the reduction of serum cholesterol that averages about 5% more than can be accounted for by weight loss alone. In clinical trials it produces a 5-10% loss of weight. Its side effects are entirely due to undigested fat in the intestine that can lead to increased frequency and change in the character of stools. It can also lower fat-soluble vitamins. The ingestion of a vitamin supplement before bedtime is a reasonable treatment strategy. The effect on weight loss during long-term trials with these two drugs is shown in Figs 7 and 8 above. Also in this figure is data on phentermine used in trials of six months or more. Although there were differences in mean weight losses with these drugs, when the placebo effect was taken into account they all had a surprisingly similar magnitude of weight loss.
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页码:403 / 418
页数:15
相关论文
共 77 条
[1]  
Bray G.A., Greenway F.L., Current and potential drugs for treatment of obesity, Endocr Rev, 20, pp. 805-875, (1999)
[2]  
Weintraub M., Bray G.A., Drug treatment of obesity, Med Clin North am, 73, pp. 237-249, (1989)
[3]  
Bray G.A., Obesity - A time-bomb to be defused, Lancet, 352, pp. 160-161, (1998)
[4]  
Ryan D.H., Bray G.A., Helmcke F., Et al., Serial echocardiographic and clinical evaluation of valvular regurgitation before, during, and after treatment with fenfluramine or dexfenfluramine and mazindol or phentermine, Obes Res, 7, pp. 313-322, (1999)
[5]  
McMahon F.G., Fujioka K., Singh B.N., Mendel C.M., Rowe E., Rolston K., Johnson F., Mooradian A.D., Efficacy and safety of sibutramine in obese white and African-American patients with hypertension, Arch int Med, 160, pp. 2185-2191, (2000)
[6]  
Finer N., James W.P., Kopelman P.G., Lean M.E., Williams G., One-year treatment of obesity: A randomized, double-blind, placebo-controlled, multicentre study of orlistat, a gastrointestinal lipase inhibitor, Int J Obes Relat Metab Disord, 24, pp. 306-313, (2000)
[7]  
Flechtner-Mors M., Ditschuneit H.H., Johnson T.D., Suchard M.A., Adler G., Metabolic and weight loss effects of long-term dietary intervention in obese patients: Four-year results, Obes Res, 8, pp. 399-402, (2000)
[8]  
Munro J.F., MacCuish A.C., Wilson E.M., Et al., Comparison of continuous and intermittent anorectic therapy in obesity, Br Med J, 1, pp. 352-354, (1968)
[9]  
Greenway F.L., Ryan D.H., Bray G.A., Rood J.C., Tucker E.W., Smith S.R., Pharmaceutical cost savings of treating obesity with weight loss medications, Obes Res, 7, pp. 523-531, (1999)
[10]  
Astrup A., Breum L., Tourbro S., Et al., The effect and satiety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placeo in obese subjects on an energy restricted diet. A double blind trial, Int J Obes, 16, pp. 260-277, (1992)