Appetite suppressants

synonym

Anoretics, anti-obesity drugs

introduction

Appetite suppressants are a group of active ingredients, some of which are very different, with the aim of reducing weight.

The way in which this goal is achieved varies. The few drugs that are approved for the treatment of obesity or are in development can be roughly divided into three groups according to their mechanism of action:

1. The first group achieves weight reduction by reducing appetite or increasing the feeling of satiety. It directly attacks the responsible point in the central nervous system (CNS), the hypothalamus.
2. A second group inhibits the absorption of certain food components, particularly fats, in the intestine.
3. A third group consists of active ingredients that are structurally similar to the body's own hormones from the gastrointestinal tract and thus imitate their effects.

There are other active ingredients with different mechanisms, some are being tested for the treatment of obesity, others are not indicated for the treatment of obesity but have different areas of application. So increase for example Thyroid hormones (Thyroxine) den Basal metabolic ratewhich leads to a faster breakdown of ingested calories.

Indications

As the name suggests, is the application of Anti-obesity the patient group with Obesity Reserved.

Overweight actually in need of treatment in the sense of obesity (Obesity) by definition consists of one Body mass index from 30 kg / m2, but also patients with a BMI over 25 kg / m2 or 28 kg / m2 may require treatment if they already have more Risk factors for the Cardiovascular system (cardiovascular risk factors) such as one high blood pressure or very high cholesterol (Hypercholesterolemia) exhibit.

The more of these risk factors a patient has, the higher the risk for diseases of the cardiovascular system, for example

• coronary heart disease
• Heart attack or
• stroke

Please also read our topic on this Consequences of being overweight.

Approved active ingredients

In Germany, four active substances are currently approved for the treatment of obesity.

Orlistat reduces the absorption (absorption) of fats in the gastrointestinal tract by inhibiting the enzymes (lipases) responsible for breaking down fats. In studies, it was combined with a low-fat diet. The weight loss of patients who were on a diet and taking orlistat was compared to those who were on a diet and taking placebo (a drug that looked like orlistat but had no active ingredient). Weight loss was seen in some patients in both groups, with the orlistat group having a higher rate of weight loss. However, the studies also showed that the patients who had lost weight on orlistat had regained their original weight within one year of stopping the drug. In the patients examined, the concentration of the unfavorable LDL cholesterol decreased during the treatment with orlistat, while that of the favorable HDL cholesterol increased. Furthermore, a decrease in the Nüchten blood sugar level and blood pressure was found. Orlistat thus had a positive effect on many of the cardiovascular risk factors. Orlistat should not be taken for more than six months at a time. If there is no reduction in weight of at least 5% of the initial weight after 12 weeks, the treatment should be discontinued. The side effects include primarily those that are directly related to the increased excretion of fat in the stool, such as pelvic pain, flatulence with defecation and urge to defecate up to fecal incontinence. The rate of side effects increases with a high-fat diet, which is another reason why a low-fat diet should be adhered to. Orlistat is available from pharmacies without a prescription at a price of around 32 euros for 42 capsules of 60 mg or 44 euros for 84 capsules of 60 mg.

Read more on the topic: Orlistat

Three other appetite suppressants are currently approved in Germany, all three attack directly in the central nervous system (CNS), they belong to the group of amphetamines: Amfepramon, Phenylpropanolamine (also: norephedrine) and D-norpseudoephedrine (also: cathine). These drugs release certain messenger substances (neurotransmitters) such as (nor) adrenaline from nerve cell endings and are therefore classed as indirect sympathomimetics, which means that they stimulate the sympathetic nervous system and thus increase heart rate and blood pressure, among other things. On the one hand, these messenger substances increase the energy turnover by activating the sympathetic nervous system, and on the other hand they work by suppressing appetite. The spectrum of side effects of sympathomimetics is wide because they do not only work where it is desired. So they often feed too

• nervousness
• Restlessness
• sleep disorders
• Cardiac arrhythmias
• High pressure in the pulmonary vessels (pulmonary hypertension)
• mental disorders up to psychoses (drug psychosis)

The duration of use is therefore limited to four to a maximum of 12 weeks, depending on the drug. Due to the sometimes dramatic side effect profile, the use of one of these drugs should be carefully considered, carefully considering the risks and benefits.
30 capsules with the active ingredient amfepramone cost around 29 euros (Regenon®), 30 capsules with the active ingredient phenylpropanolamine cost around 29 euros (Recatol®), 15 ml with the active ingredient norpseudoephedrine cost around 25 euros (Alvalin®).

Other active ingredients have been and will be in experimental studies checked for effectiveness. For example drugs from the group of Reuptake inhibitors from Serotonin, Norepinephrine and Dopamine (e.g. Tesofensin).

Furthermore, active ingredients are being tested that Similar to gastrointestinal hormones and partly already for the therapy of Diabetes mellitus used (e.g. exenatide). Also one combination from the amphetamine Phentermine and the Anti-epileptic Topiramate is currently being reviewed in studies. So far, this combination product has been found to be more effective than orlistat, with less impairment from side effects.

In addition to these drugs, there are still numerous herbal remedies or funds from the branch of alternative medicine that can be used for weight loss. It should be noted that herbal remedies are not generally harmless. Such active ingredients can also severe side effects especially if they are misused and used without medical supervision.

The group of herbal appetite suppressants include "natural stimulants" how

• caffeine, Mate or black tea
• ballast- and Swelling substances like guar and psyllium and
• Active ingredients that increase energy expenditure (herbal sympathomimetics) such as Ephedrine

outlook

So far there is no drug that combines the combination good effectiveness and at the same time very good tolerance knows how to combine well enough. There is also the problem of the misuse of over-the-counter or herbal appetite suppressants, which are partly due to their not inconsiderable side effects dangerous consequences can lead to. Numerous active ingredients are still being tested.