Centrally acting appetite SIBUTRAMINE HYDROCHLORIDE

4.5.2 Centrally acting appetite SIBUTRAMINE HYDROCHLORIDE

suppressants Indications adjunct in obesity (see notes above)

Cautions monitor blood pressure and pulse rate (every

2 weeks for first 3 months then monthly for 3 months Sibutramine inhibits the re-uptake of noradrenaline and

then at least every 3 months)—discontinue if blood serotonin. It is used in the adjunctive management of

pressure exceeds 145/90 mmHg or if systolic or dia- obesity in individuals with a body mass index (BMI) of

stolic pressure raised by more than 10 mmHg or if

30 kg/m or more (and no associated co-morbidity) or pulse rate raised by 10 beats per minute at 2 con- in individuals with a BMI of 27 kg/m or more in the

secutive visits; sleep apnoea syndrome (increased risk presence of other risk factors such as type 2 diabetes or

of hypertension); epilepsy; open-angle glaucoma, dyslipidaemia. Sibutramine is not licensed for use for

susceptibility to angle-closure glaucoma, history of longer than 1 year; on stopping sibutramine, there may

ocular hypertension; monitor for pulmonary hyper-

be a gradual reversal of weight loss. tension; family history of motor or vocal tics, history Rimonabant is a cannabinoid receptor antagonist for

of depression; predisposition to bleeding, concomi- the adjunctive management of obesity in individuals

tant use of drugs that increase risk of bleeding; hepatic with a BMI of 30 kg/m or more, or in individuals

impairment (avoid if severe; Appendix 2); renal with a BMI above 27 kg/m in the presence of other

impairment (avoid if creatinine clearance less than risk factors such as type 2 diabetes or dyslipidaemia. On

30 mL/minute; Appendix 3); interactions: Appendix stopping rimonabant, there may be a gradual reversal of

1 (sibutramine)

weight loss. Contra-indications history of major eating disorders; Rimonabant

psychiatric illness, Tourette syndrome; history of The marketing authorisation for rimonabant has

coronary artery disease, congestive heart failure, been suspended following a review by the CHMP.

tachycardia, peripheral arterial occlusive disease, The CHMP concluded that the benefits of rimona-

arrhythmias, and of cerebrovascular disease; uncon- bant treatment do not outweigh the risks of psychia-

trolled hypertension; hyperthyroidism; prostatic tric adverse reactions. Prescribers should not issue

hypertrophy; phaeochromocytoma; history of drug or prescriptions for rimonabant; treatment of patients

alcohol abuse; pregnancy (Appendix 4); breast-feed- who are taking rimonabant should be reviewed.

ing (Appendix 5) Side-effects constipation, dry mouth, nausea, taste

Dexfenfluramine, diethylpropion, fenfluramine, and disturbances, diarrhoea, vomiting, gastro-intestinal

phentermine have been associated with valvular heart haemorrhage, haemorrhoid aggravation; tachycardia,

entral

disease and the rare but serious risk of pulmonary palpitation, arrhythmias, hypertension, flushing; hypertension.

insomnia, lightheadedness, paraesthesia, headache, anxiety, depression, seizures, transient memory dis-

nervous

turbance; sexual dysfunction, menstrual disturbances, urinary retention; thrombocytopenia; blurred vision;

RIMONABANT sweating, alopecia, cutaneous bleeding disorders,

syst

hypersensitivity reactions including Henoch-Scho¨n-

Indications adjunct in obesity (see notes above) lein purpura, rash, urticaria, angioedema and

em

Cautions epilepsy; history of suicidal ideation or of anaphylaxis; interstitial nephritis, glomerulonephritis; depressive disorder (avoid unless no alternative);

rarely headache and increased appetite on withdrawal; elderly over 75 years; hepatic impairment (avoid if

very rarely angle-closure glaucoma severe—Appendix 2); interactions: Appendix 1

Dose

(rimonabant) . Initially 10 mg daily in the morning, increased if Contra-indications major depressive illness, conco-

weight loss less than 2 kg after 4 weeks to 15 mg daily; mitant treatment with antidepressant; uncontrolled

discontinue if weight loss less than 2 kg after 4 weeks psychiatric illness; severe renal impairment;

at higher dose (see also Discontinuation of Treatment pregnancy (Appendix 4); breast-feeding (Appendix 5)

below); max. period of treatment 1 year; CHILD over 12 Depression Patients and carers should be informed of the

years, initiated by specialist only [unlicensed use]; risk of depression and advised to stop treatment and seek medical attention if symptoms occur

ELDERLY over 65 years not recommended Discontinuation of treatment

Side-effects Discontinue treatment if:

nausea, vomiting, diarrhoea, dry mouth, anorexia; depression (see above), anxiety, irritability, . weight loss after 3 months less than 5% of initial body- weight;

nervousness, sleep disorders, impaired memory, diz-

weight loss stabilises at less than 5% of initial body- ziness, paraesthesia, hypoaesthesia, sciatica, hot

weight;

flush, asthenia, impaired attention; tendonitis, muscle

individuals regain 3 kg or more after previous weight cramp; pruritus, hyperhidrosis; less commonly hiccups,

loss

anger, aggression, suicidal ideation; rarely hallucina- In individuals with co-morbid conditions, treatment should tions

be continued only if weight loss is associated with other Dose

clinical benefits

. See Rimonabant, above; ADULT over 18 years 20 mg daily before breakfast

Reductil (Abbott) A (Sanofi-Aventis) TA

Acomplia c

Capsules , sibutramine hydrochloride 10 mg (blue/ Tablets , f/c, rimonabant 20 mg, net price 28-tab pack

yellow), net price 28-cap pack = £25.00; 15 mg (blue/ = £44.00. Counselling, depression (see above)

white), 28-cap pack = £25.00