Management of obesity and cardiometabolic risk &amp;ndash; role of phentermine/extended release topiramate

Sweeting, Arianne; Tabet, Eddy J; Caterson, Ian D.; Markovic, Tania

doi:10.2147/dmso.s38979

Cited by 13 publications

(6 citation statements)

References 45 publications

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“…Phentermine (2-methyl-1-phenylpropan-2-amine) is a sympathomimetic amine approved by the FDA in 1959 for short-term (≤12 wk) weight management as an adjunct to caloric restriction and lifestyle modifications for obese and overweight individuals with weight-related comorbidities (Sweeting et al, 2014). Phentermine is the most commonly prescribed anti-obesity medication in the United States (Hampp et al, 2013).…”

Section: Pharmacotherapies For Obesitymentioning

confidence: 99%

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Obesity: Current and potential pharmacotherapeutics and targets

Narayanaswami

Dwoskin

2017

Pharmacology & Therapeutics

157

121

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Obesity is a global epidemic that contributes to a number of health complications including cardiovascular disease, type 2 diabetes, cancer and neuropsychiatric disorders. Pharmacotherapeutic strategies to treat obesity are urgently needed. Research over the past two decades has increased substantially our knowledge of central and peripheral mechanisms underlying homeostatic energy balance. Homeostatic mechanisms involve multiple components including neuronal circuits, some originating in hypothalamus and brain stem, as well as peripherally-derived satiety, hunger and adiposity signals that modulate neural activity and regulate eating behavior. Dysregulation of one or more of these homeostatic components results in obesity. Coincident with obesity, reward mechanisms that regulate hedonic aspects of food intake override the homeostatic regulation of eating. In addition to functional interactions between homeostatic and reward systems in the regulation of food intake, homeostatic signals have the ability to alter vulnerability to drug abuse. Regarding the treatment of obesity, pharmacological monotherapies primarily focus on a single protein target. FDA-approved monotherapy options include phentermine (Adipex-P®), orlistat (Xenical®), lorcaserin (Belviq®) and liraglutide (Saxenda®). However, monotherapies have limited efficacy, in part due to the recruitment of alternate and counter-regulatory pathways. Consequently, a multi-target approach may provide greater benefit. Recently, two combination products have been approved by the FDA to treat obesity, including phentermine/topiramate (Qsymia®) and naltrexone/bupropion (Contrave®). The current review provides an overview of homeostatic and reward mechanisms that regulate energy balance, potential therapeutic targets for obesity and current treatment options, including some candidate therapeutics in clinical development. Finally, challenges in anti-obesity drug development are discussed.

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Section: Pharmacotherapies For Obesitymentioning

confidence: 99%

“…The most common adverse events include dry mouth and insomnia (Yanovski and Yanovski, 2014). Serious complications include palpitations, tachycardia and hypertension (Sweeting et al, 2014). Long-term, dose-ranging clinical trials are needed to confirm the safety and efficacy of phentermine as an anti-obesity therapeutic.…”

Section: Pharmacotherapies For Obesitymentioning

confidence: 99%

Obesity: Current and potential pharmacotherapeutics and targets

Narayanaswami

Dwoskin

2017

Pharmacology & Therapeutics

157

121

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“…In this case, phentermine, diethylpropion, or topiramate may be better options. 13 , 14 , 31 Amphetamine use, due to addictive properties, is not advisable.…”

Section: Special Patient Populationsmentioning

confidence: 99%

Naltrexone HCI/bupropion HCI for chronic weight management in obese adults: patient selection and perspectives

Tek¹

2016

PPA

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Naltrexone, an opiate antagonist, and bupropion, a noradrenergic/dopaminergic antidepressant, have many effects on the reward systems of the brain. These medications impact eating behavior, presumably via their impact on food reward. However, only bupropion induces weight loss in obese individuals, while naltrexone does not have any appreciable effect. The combination of 32 mg of naltrexone and 360 mg of bupropion in a sustained-release combination pill form has been recently approved for obesity treatment. Studies have shown that the combination of these two medications is more effective in inducing weight loss, when combined with lifestyle intervention and calorie reduction, than each individual medicine alone. The naltrexone–bupropion combination, when combined with lifestyle intervention and modest calorie reduction, seems to be quite effective for 6-month and 1-year outcomes for clinically significant weight loss (over 5% of total body weight). These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. This paper reviews existing weight loss clinical trials with bupropion and the bupropion–naltrexone combination. Additionally, the rationale for the suggested patient selection and clinical strategies for special patient populations are discussed.

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“…Indeed, the modes of action of topiramate on energy intake are still poorly understood. However, this novel drug combination is efficacious, showing a weight reduction of approximately 10%, and is regarded as a safe treatment option [ 23 ]. Recently it has been demonstrated that this combination is also able to prevent diabetes in a pre-diabetic population [ 24 , 25 ].…”

Section: Medical Treatment For Obesity – Regulatory Updatementioning

confidence: 99%