Sibutramine (brand name Meridia) was recently (November, 1997) approved 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 both norepinephrine and serotonin by interfering with the breakdown of these substances. Norepinephrine and serotonin are both neurotransmitters (or messengers) in the brain that lead to stimulation of other neurons (brain cells). Sibutramine tends to diminish appetite and also (to a lesser degree), increases the resting metabolic rate leading to the ability to "burn" extra calories.
Unlike dexfenfluramine and fenfluramine, the medication does not cause the 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 which was found in similar testing using animals treated with 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 lost (on average) about 10 lbs (4.3 kg.) more than placebo treated individuals when placed on sibutramine 15 mg. daily. Some individuals, however, had a much more significant weight loss.
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. Individuals treated with this medication should have regular medical follow-up.
In summary, sibutramine is a medication that will be available shortly in the United States that 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.
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