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