Beruflich Dokumente
Kultur Dokumente
Control of availability of substrates to cells mainly through hormonal and other metabolic factors available at the energy substrate Control of fat reserves through modulation of Lipogenesis
OBESITY:DRUG TREATMENT
Dr.R.N.MISHRA
PG.DEPT. OF PHARMACOLOGY Hi-Tech MEDICAL COLLEGE
CORPULENCY,
WHEN
IN
AN
OBSTRUCTS THE
DISTEMPERS
A SHORT HISTORY
1.
2. 1893-THYROID EXTRACT. 1933-DNF.NEUROPATHY,CATARACT
3.
4.
1937-AMPHEAMINE.ADDICTION
1967-AMPHETAMINE+DIGITALIS+DIURETIC SEVERAL DEATHS
5.
6. 7. 8.
OF THE DRUGS
CAUCASIANS-BMI:25-29-OVERWEIGHT BMI:30 OR MORE-OBESE SOUTH ASIANS-BMI:23-24.9-OVERWEIGHT BMI:=>25-OBESE (NORMAL:18-22.9) WAISTLINE MEN:CAUCASIANS-102 cm. SOUTH ASIANS-90cm. WOMEN:CAUCASIANS-88cm. SOUTH ASIANS-80cm.
E. FBS BY 50%
INCREASE IN HDL:8%
BASIC RULES:
1. 2. NEVER FOR COSMETIC PURPOSES ALWAYS COMBINE WITH HEALTHY EATING AND PHYSICAL EXERCISE SUBJECT SHOULD HAVE TRIED WEIGHT LOSS THRU DIET AND PHYSICAL ACTIVIES
3.
1.BMI:>30
APROVAL:
1. 2. 3. 4.
A .ANTI-DEPRESSANTS: 1. BUPROPION 2. SERTRALINE 3. VENLAFAXINE 4. FLUOXETINE ETC. B. ANTI-CONVUSANTS: 1. TOPIRAMATE 2. ZONISAMIDE C. METFORMIN
COMBINATIONS:
FLUOXETINE+PHENTERMINE
ORLISTAT+SIBUTRAMINE
PHENDIMETRAZINE+PHENTERMINE HERBALS
SAFETY UNKNOWN
NAME
FDA APPROVAL
YES.UP TO ONE YR. ADULTS
TYPE
SIDE EFFECTS
BP, PR INCREASE
1. SIBUTRAMINE
APETITE SUPPRESANT
2. PHENTERMINE
-DO-
3. PHENDIMETRAZINE
-DO-
-DO-
NAME
FDA APPROVAL
TYPE
SIDE EFFECT S
GI ISSUES
5. ORLISTAT
6. BUPROPION
DRY MOUTH, INSOMNIA TASTE CHANGE, NUMBNESS DRY MOUTH, DROWSINESS, DIZZINESS,HEA DACHE,NAUSEA
7. TOPIRAMATE
NO
8. ZONISAMIDE
NO
DO
HOW LONG:
1. EFFICACY
2.
SIDE EFFECTS
ONE RECENT STUDY:1 MONTH ON AND 1 MONTH OFF SHOWED EFFICACY OF SIBUTRAMINE TO LOSE AND MAINTAIN WT. FOR >2 YEARS
EFFICACY-RECENT EVIDENCES
A.FIVE LONG-TERM STUDIES WITH SIBUTRAMINEMEAN WT. REDUCTION: 4.45Kgs FOR SIBUTRAMINE vs. PLACEBO DECREASE IN WAIST CIRCUMFERENCE DECREASE IN TG,URIC ACID INCREASE IN HDL IMPROVED GLYCATED Hb. IN DIABETICS BP-CNNFLICTING RESULTS.MINIMAL TO MODEST INCREASE IN DIFFERENT STUDIES INCREASE IN PULSE RATE
B.ORLISTAT:META-ANALYSIS OF 22 STUDIES ALL LASTING FOR >12 MONTHS(MEAN BMI:36.7) WITH ORLIST+DIET/BEHAVIOUR THERAPY: 1. AVERAGE WT. LOSS:2.89 Kgs 2. SIGNIFICANT DECREASE IN WAISTLINE,BP,TC, LDL-C 3. NO EFFECT ON HDL,TG 4. SIGNIFICANT IMPROVEMENT IN IGT IN DIABETICS
CONTD. RIO STUDY:n=6600 OVERWEIGHT OR OBESE INDIVIDUALS EFFECT OF RIMONABANT OVER AND BEYOND 600 Kcal RESTRICTION FOUR DOUBLE BLIND TRIALS(RIO-NORTH AMERICA,RIOEUROPE,RIO-LIPIDS,RIO-DIABETES) DECREASE IN WT. BY 5.3 Kgs DECREASE IN WAIST-LINE,TG INCREASE IN HDL NO SIGNIFICANT DECREASE IN LDL RIO-LIPIDS-DECREASE IN SMALL DENSE LDL RIO-DIABETES:HbA1c IMPROVED BY .7% CONCLUSION:3 AVAILABLE DRUGS IN EUROPE ASSOCIATED WITH IMPROVEMENT OF CARDIOMETABOLIC RISK FACTORS
OBESITY HAS REACHED AN EPIDEMIC PROPORTION MANAGEMENT-A CHALLENGE AS RAPID EVOLUTION OF UNFAVOURABLE LIFE-STYLE
CURRENTLY NO EFFECTIVE Rx. FOR MAJORITY POTENTIAL OF BENEFIT IS ENORMOUS
CONCLUSION: