SIBUTRAMINE - a Medication to Assist with Weight Management
Sibutramine (brand name Meridia) was approved in November, 1997 by the U.S. F.D.A. for use in weight management. Sibutramine was developed in the late 80's as an antidepressant. It acts in areas of the brain that control not only mood and sense of well-being but also control appetite. It is a monoamine reuptake inhibitor that increases the level of norepinephrine, serotonin, and to a lesser extent dopamine that is available to brain cells (neurons) by interfering with the reabsorption of these substances by the neurons that initially released them. Norepinephrine, serotonin, and dopamine are neurotransmitters (or messengers) in the brain that lead to stimulation of other neurons .Sibutramine acts primarily by diminishing appetite but may also slightly increase resting metabolic rate (the amount of energy consumed while resting) leading to the ability to "burn" extra calories. However, some studies indicate that there is no increase in metabolic rate in individuals utilizing sibutramine. It is possible that sibutramine results in weight loss by other yet undefined mechanisms.
Unlike dexfenfluramine and fenfluramine, the medication does not cause release of serotonin from neurons. Tests done on humans show no evidence of valvular heart disease and experiments done on animals show no evidence of the neurotoxicity (brain damage), unlike the finding on test animals using the previously available medication fenfluramine and dexfenfluramine.
Clinical studies utilizing the medication in conjunction with a low calorie diet, exercise and behavior modification show that after 12 months, individuals placed on sibutramine 15 mg. daily lost (on average) about 10 lbs (4.3 kg.) more than placebo-treated individuals. Some individuals, however, had a much more significant weight loss. As with many other weight loss medications, weight loss plateaus and then may slowly increase.
Sibutramine does have other beneficial effects that are independent of the weight loss. Sibutramine lowers insulin levels (which should help correct some of the metabolic derangements associated with long-standing obesity) and it significantly raises the level of HDL-cholesterol ("the good cholesterol") which may result in decreasing vascular complication in the future.
Like all medications, sibutramine has side effects. It can cause constipation, insomnia, and agitation. Probably the most significant side effect is that it can raise blood pressure, sometimes significantly. Combining sibutramine with other anorexiant (appetite suppressant) medications is not recommended. Individuals treated with this medication should have regular medical follow-up.
In summary, sibutramine is available in the United States and may be beneficial for selected individuals to assist with weight management. The medication must be combined with a low calorie diet, exercise, and behavioral modification to achieve the desired results.
Last modified: August 2001.
Copyright © 1996 -2001
Michael D. Myers M.D. Inc.
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The above information is for general purposes only and should not be construed as definitive or binding medical advice. Because each person is medically different, individuals should consult their own personal physicians for specific information and/or treatment recommendations.