Weight Loss Drugs (continued)
Drugs Available Now
Xenical (orlistat) by Genentech
A lipase inhibitor (fat blocker), Xenical causes less fat (30 percent of fat and calories) to be absorbed in the gut. Side effects include diarrhea from eating fatty foods when taking the medication. In the spring of 2010, the FDA issued a safety warning about this drug and its over-the-counter version, Alli (below). Some people who take orlistat are potentially at risk for liver failure. The drug label has been revised to include new safety information about the rare occurrence of severe liver injury.
Alli (orlistat 60 mg) by GlaxoSmithKline
An over-the-counter orlistat medication sold in 60 mg instead of 120 mg doses (Xenical). Side effects include diarrhea and the same risk of liver failure as for prescription orlistat. Cost: approximately $120 per month. The FDA also warns that counterfeit Alli refill kits are being sold online. These kits don't contain orlistat; instead, they contain sibutramide (Meridia), which was withdrawn from sale in 2010 (see below).
Tenuate (diethylproprion 25 mg and 75 mg) by Marion Merrell Dow
An appetite suppressant, Tenuate (diethylproprion) is recommended only for short-term use (just a few weeks) in combination with dieting for weight loss. This drug may affect blood sugar levels in people with diabetes and may cover up the signs and symptoms of hypoglycemia. Because Tenuate is similar to amphetamine drugs, it can be habit-forming. It may cause dizziness, blurred vision, or restlessness; people are advised to use caution when driving, operating machinery, or performing other hazardous activities.
Adipex-P (phentermine 8 mg)
Adipex-P (phentermine) is an appetite suppressant designed for short-term use (three to six weeks) in combination with a weight-loss diet and exercise. People are advised not take Adipex-P if they take any sort of SSRI drug such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). If you take insulin, they advise that you may need a larger dose when taking this drug. Adipex-P may also interact badly with some blood pressure drugs.
Qsymia (phentermine/topiramate extended-release) by Vivus
This drug combines two FDA-approved medications—phentermine and topiramate—in an extended-release formula. Phentermine helps short-term weight loss, and topiramate (an epilepsy and migraine medicine) triggers satiety. Trial results showed that after a year of taking Qsymia, patients prescribed the highest dose lost on average 8.9 percent of their total body weight, and those taking the recommended dose experienced a 6.7 percent weight loss compared to treatment with a placebo. This drug is not recommended for patients with glaucoma, hyperthyroidism, or for patients who recently experienced a heart attack or stroke. Because the drug can increase heart rate, regular monitoring is recommended.
Belviq (lorcaserin hydrochloride)
This drug works to control appetite and metabolism. It is approved for adults with a body mass index greater than 30 or for those adults who have a BMI of 27 or greater who also have high blood pressure, type 2 diabetes, or high cholesterol. The drug works to stimulate the serotonin 2CV receptor in the brain, which may help patients feel fuller after eating less. In clinical trials, thirty-eight percent of patients (without type 2 diabetes) lost at least 5 percent of their total body weight, compared to 16 percent of patients treated with a placebo. The FDA reports positive affects in glycemic control for patients with type 2 diabetes. The drug's negative side effects include migraines. For patients with diabetes, common side effects also include hypoglycemia, headache, back pain, cough, and fatigue. Memory and attention problems, as well as serotonin syndrome are other side effects to note.
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My diabetes is changing. Until a few years ago, my morning readings were reasonable and within the desired range of under 100 mg/dl. About two years ago, they started slipping upwards into the less-desirable but apparently not-worrisome range of 100-110 mg/dl. Now, this was what was recorded by my Abbott Freestyle Lite meter, which is known to record at the lower end of the home-glucometer variability range, but with my A1c firmly in the high 5s and low 6s, the meter's tendency to...