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Orlistat (Xical), a drug commonly used to treat obesity, and sibutramine (Meridia), a drug that was quickly withdrawn due to cardiovascular side effects.
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Anti-obesity drugs or weight loss drugs are pharmacological agents that reduce or control weight. These drugs change one of the main processes in the human body, the regulation of weight, appetite or the absorption of calories.
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Diet (healthy eating and calorie restriction) and exercise remain the primary treatment for overweight and obese people.
In the United States, orlistat (Xical) and semaglutide (Wegovy) are currently FDA-approved for long-term use.
Xical reduces intestinal fat absorption by inhibiting pancreatic lipase; Wegovy is a GLP-1 analogue, a class of drugs that is relatively safe and shows promise as an effective anti-obesity measure.
Because of the limited potential effects and small benefits of weight loss in obese children and adolescents,
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Anti-obesity drugs are recommended to be prescribed only for obesity if the benefits of the treatment outweigh its risks.
In the United States, the Food and Drug Administration promotes adequate recovery in the population for people with a body mass index of at least 30 or a body mass index of at least 27 with at least one disease related to weight. high health risks to justify the use of anti-obesity drugs.
Anoretics are primarily designed to suppress appetite, but many drugs in this class also act as stimulants (eg, amphetamines), and patients abuse “off-label” appetite suppressants ( eg, digoxin).
The first described attempts to lose weight were the actions of the Greek physician Soran of Ephesus in the second century AD. He prescribed laxatives and cleansing elixirs, as well as heat, massage, and exercise. It has remained the basis of treatment for over a thousand years. It was only in the 1920s and 1930s that new treatment methods began to appear. Thyroid hormone has become a popular treatment for obesity in euthyroid people based on its effectiveness against hypothyroidism. It has little effect, but causes symptoms of hyperthyroidism as side effects, such as palpitations and difficulty sleeping. 2, 4-Dinitrophol (DNP) was introduced in 1933; It works by disrupting the biological process of oxidative phosphorylation in mitochondria, causing them to generate heat instead of ATP. The most important side effect is a feeling of warmth, which is often accompanied by sweating. Overdose, although rare, results in increased body temperature and ultimately fatal hyperthermia. By 1938, DNP was no longer available because the FDA had the power to force manufacturers to voluntarily withdraw it from the market.
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Amphetamines (sold as Bzedrine) became popular for weight loss in the late 1930s. They work primarily by suppressing the appetite and have other beneficial effects such as increased alertness. In the following decades, the use of amphetamines increased, including Obetrol and ending in the “rainbow diet pill” regimen.
It was a combination of several pills that helped me lose weight during the day. Common regimens include stimulants such as amphetamines, as well as thyroid hormones, diuretics, digitalis, laxatives, and often barbiturates to counteract the side effects of the stimulants.
In 1967/1968, a series of deaths related to diet pills led to a government investigation and gradually further restrictions on the market.
Although rainbow diet pills were banned in the US in the late 1960s, they made a comeback in South America and Europe in the 1980s.
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Rainbow diet pills were eventually reintroduced in the US in the 2000s, with additional negative health effects.
In 1959, ftermine was approved by the FDA, and in 1973, fluramine was approved. The two drugs were not more popular than other drugs until a researcher reported in 1992 that the combination of the two drugs resulted in a 10% weight loss, which lasted more than two years.
F-ph was born and quickly became the most prescribed diet pill. Dexfluramine (Redux) was developed in the mid-1990s as an alternative to fluramine with fewer side effects and received regulatory approval in 1996. However, there is considerable evidence that this combination may cause up to 30% of valvular disease. heart. those who took it led to the withdrawal of F-ph and dexfluramine from the market in September 1997.
Medical complications include fatal pulmonary hypertension and heart valve damage due to Redux and F-ph and hemorrhagic stroke due to filpropanolamine.
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Since the introduction of drugs to treat obesity in the 1930s, many compounds have been tested. Most of them reduce body weight by a small amount and some of them are not marketed for obesity because of the side effects. Of the 25 anti-obesity drugs taken off the market between 1964 and 2009, 23 work by changing the functions of neurotransmitter chemicals in the brain. The most common side effects that lead to the withdrawal of these drugs are mental disorders, cardiac side effects, and drug abuse or drug use. The deaths were reported to be linked to 7 products.
Ephedra was taken off the US market in 2004 because it raises blood pressure and can cause stroke and death.
Some patients find that diet and exercise are not enough; For these patients, anti-obesity drugs may be a last resort. In the United States, semaglutide (Wegovy) is FDA approved for chronic weight management.
Some prescription weight loss medications are stimulants, which are recommended for short-term use only and therefore have limited benefit to patients who need to lose weight over months or years.
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A 2021 review concluded that “Intestinal peptide analogs such as semaglutide […] and […] tirzepatide are currently the most advanced in clinical development.”
A follow-up review in 2022 concluded that these two peptides are “the most promising candidates for the future combat in the anti-obesity market.”
An article in The New York Times noted the high cost of semaglutide and topical tirzepatide, suggesting that “many people who would benefit most from weight loss cannot afford such expensive drugs.”
In June 2021, the US Food and Drug Administration (FDA) approved semaglutide injection, sold under the brand name Wegovy, for long-term weight management in adults.
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Wegovy was approved for medical use in the European Union in January 2022 (“in combination with food and physical activity”).
Specifically, Phase 3 clinical trials showed that after 71 weeks, subjects lost an average of 16 percent of their baseline body weight.
On May 13, 2022, it was approved under the name Mounjaro for type 2 diabetes (although not specifically for weight loss).
Exatide (Byetta) is a long-acting analog of the hormone GLP-1, which is secreted in the intestines in response to a previous eating situation. Among other effects, GLP-1 delays gastric emptying and promotes a feeling of fullness after eating. Some obese people have GLP-1 deficiency, and dieting can even reduce GLP-1.
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Byetta is now available as a treatment for type 2 diabetes. Some, but not all, patients find that they lose a lot of weight when taking Byetta. The disadvantages of Byetta are that it must be administered subcutaneously twice a day and it causes severe nausea in some patients, especially at the beginning of therapy. Since 2015, Byetta is only recommended for patients with type 2 diabetes.
Orlistat (Xical) reduces intestinal fat absorption by inhibiting pancreatic lipase. Steatorrhea with frequent fatty bowel movements is a possible side effect of using Orlistat. But when the amount of fat in the diet is reduced, the symptoms improve. Originally available only by prescription, it was approved for over-the-counter sale by the FDA in February 2007.
On May 26, 2010, the US Food and Drug Administration (FDA) approved a revised label for Xical, a new safety warning regarding rare cases of severe liver damage reported with the drug.
Cetilistat is a drug used to treat obesity. It works in the same way as the older drug Orlistat by inhibiting pancreatic lipase, the enzyme that breaks down triglycerides in the intestine. Without this enzyme, dietary triglycerides are prevented from being hydrolyzed into absorbed free fatty acids and excreted undigested.
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The combination of Ftermin and topiramate, brand name Qsymia (formerly Qnexa), was approved by the US FDA on July 17, 2012 as an adjunct to diet and exercise regimens for the treatment of obesity.
In October 2012, the European Medicines Agency, in contrast, rejected the combination (Qsiva) as an obesity drug, citing concerns about long-term effects on the heart and blood vessels, and health effects. and thinking.
Naltrexone/bupropion is a combination drug used for weight loss in obese or overweight people with weight-related disorders. It combines low doses of bupropion and naltrexone. Both drugs individually have been proven to be effective in weight loss, and the combination shows some synergistic effect on weight. A sustained release formulation in September 2014
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