Upload
noura-aljohani
View
21
Download
4
Tags:
Embed Size (px)
Citation preview
Safety and Efficacy of Weight Loss Supplements and Medication Used by
Adolescents'
M.S Phrm D Norah Al Johany
• Laxiatives (2nd Century)• Thyroid extract (Late 1800s)• DNP (1933 -1938)• AYDS (1940) Benzocaine• Tapeworm diet pills 1950’s• CNS Stimulant Amphetamines (1930s - 1950s ) Aminorex 1965 ,Phentermine 1959 ,Fenfluramine Sibutramine (1997-2010) Meridia
HISTORY Diet & Weight Loss Pills
• First significant guidelines since 1998!• American College of Cardiology / American
Heart Association • Very limited in pharmacotherapy• Stopped input in 2011, newer medications
approved in 2012• Diet / Exercise always cornerstone therapy
Recent Guidelines!!!
Medications Reserved For:Not achieving / sustaining weight reduction with
adequate lifestyle modifications and:
BMI 27+ kg/m2 with significant weight relatedcomorbidities (diabetes,hypertension)
ACC/AHA ObesityMedication Recommendations
Orlistat – Inhibits gastric and pancreaticlipases >> reduced fat absorption
Rx (Xenical): 120 mg three times daily (up to 1hour prior to meals)• LOTS GI ADRs: flatulence, oily stool, loose
stool• FDA 2012: Increased risk for kidney
stones/liver injury• KSA
FDA Approved Drugs /Obesity Therapy
Lorcaserin (approved 2012)• Selective serotonin 2C agonist• ADRs: HA, dizziness, nausea, dry mouth,• constipation, memory disturbances, hypoglycemia(in diabetes)• Efficacy: ~46% attain 5% wt loss, ~23% 10% loss• (good A1c reduction in patients with diabetes)• Avoid use if also taking serotonergic agents (e.g.• SSRIs)• Stop if < 5% weight loss after 12 weeks• (60)239$
Phentermine/extended-release topiramateShort term (approved 2012)ADRs: dry mouth, constipation,
insomnia, memory disturbances, increased heart rate Efficacy: 60+% attain 5% wt loss, 35-45% 10%
loss Women of childbearing age must have negative
pregnancy test before and monthly after startingStop if < 5% weight loss after 12 weeks of higher doses
FDA approves weight-management drug Contrave 2014Naltrexone is approved to treat alcohol and opioid dependence. Bupropion is approved to treat depression and seasonal affective disorder and as an aid to smoking cessation treatment.
Off-label Drugs /Obesity Therapy
• Zonisamide• Metformin• Pramlintide
• How long to treat for???• No head to head comparative studies• Long-term safety
Obesity Therapy Issues
Supplements
• weight-loss supplements differ from over-the-counter or prescription medications
• FDA does not classify them as drugs.• Unlike drugs, dietary supplements do not
require premarket review or approval by the FDA. Supplement manufacturers are responsible for determining that their products are safe and their label claims are truthful and not misleading
Supplements
FDA has issued over 30 public notifications and recalled 7 tainted weight loss products in 2014 .
1. Garinia cambogia exract2. CLA3. Raspberry Ketones 4. Apple Cider Vinegar 5. Green Coffee Bean 6. Fiber 7. Colon Cleanse
Amazon Best Sellers Weight Loss Supplements
Raspberry Ketones
CLA
Green Coffee Bean
Garinia cambogia exract
Fiber
Colon Cleanse
Patient CaseA patient is taking the maximum dose ofphentermine/topiramate for obesity.Baseline BMI is 36 kg/m2 and weight 255 lb.
What is minimal weight loss expected toconsider continuation of therapy after 12
weeks?a. 7 lbsb. 13 lbsc. 17 lbsd. 26 lbs1-
“We’re raising our children the way we raise calves for veal - keep them in
boxes, feed them too much, and allow them no exercise”.
Rich KillingsworthCenter for Disease Control and Prevention
Outline Summary