Appetite

synonym

Anoretika, Antiadiposita

introduction

Appetite suppressants are a group of very different active ingredients that aim to reduce weight.

The way in which this goal is achieved is different. The few drugs approved or under development for obesity treatment can be broadly classified into three groups according to their mechanism of action:

  1. The first group achieves weight reduction by reducing appetite or increasing satiety. It attacks directly at the appropriate point in the central nervous system (CNS), the hypothalamus.
  2. A second group inhibits the absorption of certain food components, especially fats, in the intestine.
  3. A third group consists of active ingredients whose structure is similar to endogenous hormones from the gastrointestinal tract and thus imitate their effect.

There are other drugs with other mechanisms, some of them are being tested for the treatment of obesity, others are not indicated for the treatment of obesity but have divergent indications. For example, thyroid hormones (thyroxine) increase the basal metabolic rate, resulting in faster calorie removal.

indications

As the name suggests, the use of anti-obesity is reserved for the overweight group.

By definition, overweight adiposity (obesity) requires a body-mass index of 30 kg / m2, but patients with a BMI above 25 kg / m2 or 28 kg / m2 may also need treatment if they already have it other risk factors for the cardiovascular system (cardiovascular risk factors) such as high blood pressure or high cholesterol (hypercholesterolemia).

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

  • coronary heart disease
  • Heart attack or
  • stroke

Authorized ingredients

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

Orlistat reduces the absorption (absorption) of fats in the gastrointestinal tract by inhibiting the enzymes responsible for lipolysis (lipases). In studies, it was combined with a low-fat diet. The weight loss of patients who dieted and took orlistat and those who dieted and took a placebo (drug that looked like orlistat but did not contain any drug) was compared. In both groups, weight loss was found in some patients, with the rate of patients losing weight being higher in the orlistat group. However, the studies also showed that the patients taking orlistat had regained their starting weight within one year of stopping the drug. In the patients studied, treatment with orlistat reduced the concentration of unfavorable LDL cholesterol while that of favorable HDL cholesterol increased. Furthermore, a decrease in Nüchern blood sugar and blood pressure was detected. Thus, orlistat positively affected many of the cardiovascular risk factors. Orlistat should not be taken for more than six months at a time. Unless a weight reduction of at least 5% of the starting weight is evident after 12 weeks, treatment should be discontinued. Among the side effects are primarily those that are directly related to the increased fat excretion in the stool, such as pelvic pain, flatulence with defecation and stool urgency to fecal incontinence. The rate of side effects increases with high-fat diet, therefore, a low-fat diet should be respected. Orlistat is available over the counter in the pharmacy at a price of about 32 euros for 42 capsules á 60 mg and 44 euros for 84 capsules á 60 mg.

Currently, three other appetite suppressants are approved in Germany, all three are directly involved in the central nervous system (CNS), they belong to the group of amphetamines: amfepramone, phenylpropanolamine (also: norephedrine) and D-norpseudoephedrine (also: cathin). These drugs release certain messenger substances (neurotransmitters) such as (nor) adrenaline from nerve cell endings and thus belong to the indirect sympathomimetics, which means that they stimulate the sympathetic nervous system and thus, inter alia, increase heart rate and blood pressure. On the one hand, these messenger substances increase the energy turnover through the activation of the sympathetic nervous system, on the other hand they have an appetite inhibition. The spectrum of side effects of the sympathomimetics is great because they do not only work where it is desired. So they often lead to too

  • nervousness
  • unrest
  • sleep disorders
  • Arrhythmia
  • High pressure in the pulmonary vessels ( pulmonary hypertension )
  • mental disorders to psychoses (drug psychosis)

The duration of use is therefore - depending on the drug - limited to four to a maximum of 12 weeks. Due to the sometimes dramatic side effect profile, the use of one of these drugs should be thoroughly considered under a precise risk-benefit assessment.
30 capsules with the active ingredient amfepramone cost about 29 euros (Regenon ® ), 30 capsules with the active ingredient phenylpropanolamine cost about 29 euros (Recatol ® ), 15 ml with the active ingredient norpseudoephedrine cost about 25 euros (Alvalin ® ).

Other drugs have been and will be tested in experimental studies on their effectiveness. For example, drugs from the group of reuptake inhibitors of serotonin, norepinephrine and dopamine (eg tesofensin).

Furthermore, active ingredients are being tested that are similar to the hormones of the gastrointestinal tract and in some cases already used for the treatment of diabetes mellitus (eg exenatide). A combination of amphetamine phentermine and the antiepileptic topiramate is currently being investigated in studies. So far, this combination preparation has been found to be more effective than orlistat, with less adverse effects from side effects.

In addition to these drugs, there are also numerous herbal remedies or funds from the field of alternative medicine, which can be used for weight loss. It should be noted that herbal remedies are not fundamentally harmless. Also, such drugs can have serious side effects, especially if they are used abusively and without medical supervision.

The group of herbal appetite suppressants include "natural stimulants" such as

  • Caffeine, mate or black tea
  • Ballast and swelling agents such as guar and psyllium and
  • Active ingredients that increase energy expenditure (herbal sympathomimetics) such as ephedrine

outlook

So far, there is no drug that knows how to combine the combination of good effectiveness and very good compatibility sufficiently well. There is also the problem of abuse of over-the-counter or herbal appetite suppressants, which may in part lead to dangerous consequences due to their not inconsiderable side effects. Numerous active ingredients are still in the trial.


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