Cardiovascular Safety During and After Use of Phentermine and Topiramate

Ritchey, Mary E.; Harding, Abenah; Hunter, Shannon; Peterson, Craig A.; Sager, Philip T.; Kowey, Peter R.; Nguyen, Lan; Thomas, Steven; Cainzos‐Achirica, Miguel; Rothman, Kenneth J.; Andrews, Elizabeth; Anthony, Mary S.

doi:10.1210/jc.2018-01010

Cited by 31 publications

(20 citation statements)

References 13 publications

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“…The findings of this study reinforced previous results, which revealed that the drug can result in meaningful weight loss and favorable cardiovascular profile, including BP, lipid profiles, fasting glucose, fasting insulin, and waist circumference (WC). In a recent study, the occurrence of adverse cardiovascular events among the users of phentermine/topiramate ER was less frequent than the unexposed former users [ 40 ]. Meanwhile, a study that investigated the safety and efficacy of the drug used for the treatment of moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity showed weight reduction as well as significant improvement in OSA as compared with the group treated with placebo.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

2021

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Purpose of Review As a chronic and relapsing disease, obesity impairs metabolism and causes cardiovascular diseases. Although behavioral modification is important for the treatment of obesity, it is difficult to achieve an ideal weight or sustain the process of long-term weight loss. Therefore, the obesity control guidelines strongly recommend lifestyle interventions along with medical treatment for patients who are overweight. There is sufficient evidence supporting that pharmacotherapy in combination with behavior-based interventions can result in significant weight loss and improved cardiometabolism. Recent Findings Recent meta-analyses of new anti-obesity drugs and their weight-loss efficacy have shown that the overall placebo-subtracted weight reduction (%) for at least 12 months ranged from 2.9 to 6.8% for the following drugs: phentermine/ topiramate (6.8%), liraglutide (5.4%), naltrexone/bupropion (4.0%), orlistat (2.9%), and lorcaserin (3.1%). However, very recently, on February 13, 2020, the US Food and Drug Administration (FDA) ordered the withdrawal of lorcaserin from markets, as a clinical trial to assess drug safety showed an increased risk of cancer. Currently, the anti-obesity medications that have been approved by the FDA for chronic weight management are orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide. However, they are costly and may have adverse effects in some individuals. Therefore, drug therapy should be initiated in obese individuals after weighing its benefits and risks. Summary One of the strategies for long-term obesity control is that anti-obesity medications should be tailored for specific patients depending on their chronic conditions, comorbidities, and preferences.

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Section: Introductionmentioning

confidence: 99%

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

2021

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“…Small, mostly transient, increases in heart rate are seen in some PHEN/TPM-treated subjects; however, there are no associated adverse clinical ramifications (28,29). Actually, in a very recent study, the major adverse cardiovascular events rates among current users of PHEN/ TPM combination were lower than those among unexposed former users (30). Furthermore, in a study conducted to evaluate the safety and efficacy of PHEN/TPM for the treatment of moderate-to-severe obstructive sleep apnea (OSA) in obese adults, treatment with PHEN/TPM led to significant weight reductions and concomitant improvements in OSA and related parameters, as compared with placebo.…”

Section: Phentermine/topiramatementioning

confidence: 99%

Pharmacologic therapy of obesity: mechanisms of action and cardiometabolic effects

Montan¹,

Sourlas²,

Olivero³

et al. 2019

Ann. Transl. Med.

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Obesity is a chronic, relapsing, multifactorial disease, which has become a serious threat to public health globally, as the worldwide prevalence of obesity increases exponentially over time. It has been well established that obesity is associated with multiple adverse cardiometabolic effects. Although lifestyle changes are the first line of therapy for obesity, these are often insufficient in attaining weight loss goals.Orlistat, phentermine/topiramate, lorcaserin, naltrexone/bupropion, and liraglutide are agents that have been approved for the treatment of obesity but their effects on cardiometabolic risk factors and outcomes have not been clearly elucidated. Given the detrimental repercussions of obesity on cardiometabolic health, there is a pressing clinical need to fully understand the effects of these agents beyond weight loss alone. Certain previous weight loss drugs have been withdrawn due to safety concerns and this underlines the need for more careful assessment of the effects of the various pharmacologic agents currently used for the treatment of obesity. This review aims to provide an overview of the mechanisms, efficacy, safety and cardiometabolic effects of the currently available pharmacologic agents for weight loss.

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“…When accompanied by weight loss, many anti-obesity drugs reduce CVD risk factors (i.e., orlistat, liraglutide, naltrexone/bupropion, and phentermine/topiramate are not contraindicated in patients with cardiovascular disease) [ 3 ]. Little evidence supports phentermine & topiramate combination anti-obesity agent as increasing or decreasing CVD risk among patients with obesity [ 96 ]. Phentermine is contraindicated in patients with CVD [ 3 ] Among patients with obesity, CVD and type 2 diabetes mellitus without congestive cardiomyopathy, initial drug treatments to consider include metformin and GLP-1 RA (e.g., liraglutide, semaglutide), and SGLT-2 inhibitors (e.g., empagliflozin, canagliflozin) [ 3 ].…”

Section: Overweight and Obesitymentioning

confidence: 99%

Ten things to know about ten cardiovascular disease risk factors (“ASPC Top Ten – 2020”)

Bays

2020

American Journal of Preventive Cardiology

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Preventive cardiology involves understanding and managing multiple cardiovascular disease (CVD) risk factors. Given the rapid advancements in medical science, it may be challenging for the busy clinician to remain up-to-date on the multifaceted and fundamental aspects of CVD prevention, and maintain awareness of the newest applicable guidelines. The “American Society for Preventive Cardiology (ASPC) Top Ten 2020” summarizes ten essential things to know about ten important CVD risk factors, listed in tabular formats. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and gender), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten 2020” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.

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Cardiovascular Safety During and After Use of Phentermine and Topiramate

Cited by 31 publications

References 13 publications

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

Pharmacologic therapy of obesity: mechanisms of action and cardiometabolic effects

Ten things to know about ten cardiovascular disease risk factors (“ASPC Top Ten – 2020”)

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