Use of Fluoxetine to Reduce Weight in Adults with Overweight or Obesity: Abridged Republication of the Cochrane Systematic Review

Abstract

Introduction: Using fluoxetine is one of many weight-loss strategies. A serotonin reuptake inhibitor indicated for depression believed to impact weight control by changing an individual’s appetite; however, its benefit-risk ratio is unclear. The aim of this review is to assess the efficacy and safety of fluoxetine in reducing weight in adults with overweight or obesity. Methods: We searched Cochrane Library, MEDLINE, Embase and other databases without language restrictions. Cochrane Collaboration tool and GRADE instrument assessed the risk of bias of randomised controlled trials and certainty of their evidence. We conducted random-effects meta-analyses and calculated the risk ratio/mean difference with 95% confidence intervals for the outcomes. Results: We included 19 trials (2,216 adults) and found that fluoxetine may reduce weight by −2.7 kg (95% CI −4 to −1.4; P < 0.001) and body mass index (BMI) by −1.1 kg/m2 (95% CI −3.7 to 1.4), compared with placebo; however, it would cause approximately twice as many adverse events, such as dizziness, drowsiness, fatigue, insomnia or nausea. Conclusions: Although low-certainty evidence suggests that off-label fluoxetine may reduce weight, high-certainty research is needed to be conducted in the future to determine its effects exclusively as well as whether it is useful when combined with other agents. This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews 2019, Issue 10, DOI: 10.1002/14651858. CD011688.pub2. Cochrane Reviews are regularly updated as new evidence emerges, and in response to feedback, it should be consulted for the most recent version of the review.

A nationwide pharmacovigilance investigation on trends and seriousness of adverse events induced by anti-obesity medication

“…The multivariate analysis revealed markedly elevated risk of SAEs with concomitant administration of fluoxetine and anti-obesity agents. Although fluoxetine is not classified as anti-obesity agents, studies revealed modest weight reduction of 2.7kg with fluoxetine administration; thus, it is possible that some patients may be using fluoxetine for weight loss [ 44 ]. However, considering that obese populations are at elevated risk of depression, concomitant administration of fluoxetine may be more common than reported ADE cases.…”

The Effect of a Diet Enriched with Jerusalem artichoke, Inulin, and Fluoxetine on Cognitive Functions, Neurogenesis, and the Composition of the Intestinal Microbiota in Mice

“…Similarly, research by Petersen et al [ 62 ] in BALB/c mice provided information that a 3-week supplementation of 10% of the diet with INU, FOS, XOS, GOS, apple pectin, polydextrose, or beta-glucan didn’t disturb the body weight of the tested animals. In turn, results from clinical trials showed, that FLU given chronically at a dose of 60 mg/day might have a modest effect on weight loss compared to a placebo in adults with overweight or obesity, although it may also induce many adverse events [ 63 ].…”

Risk Factors, Clinical Consequences, Prevention, and Treatment of Childhood Obesity

“…There is good evidence that obesity is associated with depression and less consistent evidence that depression is linked to obesity [ 108 ]. Among adults with overweight or obesity suffering from depression, fluoxetine showed a modest effect on weight loss as an anti-obesity medication by achieving weight loss of 2.7 kg and a decline in body mass index by 1.1 kg/m 2 compared with placebo, owing to the alleviation of hunger inhibition signals and thus reduced food intake [ 109 ]. However, further research is necessary to investigate the impact of this medication on weight loss in pediatrics.…”