I get the impression this basically a “dead” drug category, no drug companies are bringing new ones to market and no doctors are willing to prescribe them for fear of recreational use. While there is a massive obesity epidemic and lap band surgery is a booming industry, it seems stims have fallen out of use only because of drug stigma and politics.
Amphetamines and similar drugs have a very safe profile when used as directed under the supervision of a doctor, they are widely used safely for ADHD. But there seems to be a refusal to use them for weight loss, where a risky surgery is.
Is my impression totally wrong on this? The media frenzy over phen fen causing deaths was not due to the stimulant, but the other drug in that combination med.
I just find a lot of people with weight problems could benefit from appetite suppressants, but due to political reasons it is a no go.
Anxiety medications too. I have disabling anxiety to the point daily functioning is difficult, but I can’t get any doctor to prescribe anxiolytics because “I might get addicted”.
Judging by the amount of requests I get for them, they certainly are wanted by people. The true reason is that they don’t work well in the long term, there are better medications available, and they are highly addictive. But mostly, they really don’t work well and the weight comes back when they are stopped.
Interesting, thanks. I was watching a show about real patients trying to lose enough weight to get lap band surgery and it was striking that in the detailed bios they went into none seemed to have tried appetite suppressants aside from caffeine in various forms.
It seems when you are above 900 pounds the potential for getting addicted is worth the risk, your life is already ruined.
And I really doubt prescribed amphetamines are more dangerous than insane doses of caffeine some people use for energy or appetite suppression in those various products and supplements they sell OTC. Some people take outrageous amounts of caffeine daily.
The failure of rimonabant a few years ago was a massive set-back - anti-obesity drug from Sanofi-Aventis. Cannabinoid receptor inverse agonist and early indications were that it was going to be massive, even to the point of treating other addictive behaviours like smoking and drug abuse.
Psychiatric side-effects soon emerged, though, to the point where it was never approved in the US (obv a death sentence for an anti-obesity drug). Launched in Europe but withdrawn shortly after. Trying to modulate the mind’s reward systems with a single small molecule is an inordinately delicate business - fat people got sad and thoughts turned from cakes to suicide, so it had to be pulled.
If rimonabant had worked, even a little bit, then the anti-obesity field would have grown dramatically, as other companies got on the bandwagon with improved drugs. A high profile failure like that, though, sets the field back years. Kills it even as it’s probably a mechanism-based failure - ie it doesn’t really matter what your molecule is, the hypothesis is wrong.
In the early 70s I needed a physical for my drivers license. The guy I went to blatantly ran a thriving weight loss practice. He prescribed amphetamines, but required weekly exams which took two minutes and cost twenty dollars. Interesting business model. The waiting room was filled with fidgety, skinny women.
When I was called in he filled out my paperwork without looking at me or asking any questions. He gave the papers to his “nurse” (who wore what halloweeners would wear to be a “sexy nurse”). She told me it was $15. I handed her a twenty and she made change from a huge roll in her pocket.
Adipex, a stimulant based weight loss drug, is explicitly prescribed to patients who are morbidly obese. Not only that but they are recommended to use the energy the drug provides them to exercise. The medicine is only prescribed for short term use, however (two week periods).
My question to my doctor who does prescribed phentermine and Qsymia is: Why aren’t we doing more to prevent weight gain instead of only treating it after it becomes obesity? He didn’t have an answer.
And short term use of these drugs is useless. They need to be used long term. What good is two weeks?
Those drugs are extremely powerful, as well as addictive. Long term use is dangerous. The idea is to kick-start the weight loss at it’s worst and then once good habits have been initiated with the assistance of the medication, it’s no longer needed.
I’m surprised nobody has mentioned orlistat (Xenical at the RX strength; Alli at the OTC strength). I worked at the grocery store when it came out, and learned VERY quickly to dispense 10 capsules to start, and told the customers why. It was meant to be taken 3 times a day; 90 capsules cost $118 and was rarely covered by insurance. Almost all of them, within a few days, would come in and demand a refund. We couldn’t do that, but they didn’t even want them in their house any more because of the nasty side effects. They say “it can cause loose stools” but they didn’t say that it produced rectal discharge composed entirely of grease, and often couldn’t be, shall we say, contained. :eek:
In addition, I can’t recall ever refilling it. I did see it once at the hospital; the person was taking it for, of all things, high cholesterol. We told the nurse that he could bring in his own supply if he wanted to take it there, because we didn’t carry it. I don’t recall if he did or not; skipping a cholesterol med for a few days won’t hurt you.
Orlistat works by blocking intestinal absorption of dietary fat. That fat has to go somewhere, hence the “diarrhea”.
Really? You are? In a thread about stimulant appetite suppressants, you are surprised that no one has mentioned a non-stimulant, non-appetite suppressing, weight loss drug?
If they’re stimulants, wouldn’t there be a problem with them being diverted for recreational use? I know a lot of doctors are reluctant to prescribe pain medications for this reason.
