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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The acceptance of medication as a legitimate adjunct to diet and behavior modification in the treatment for obesity is an emerging phenomenon spurred by advances in understanding the biologic basis of body weight regulation and by the demonstration of safe and effective chronic maintenance of weight loss using a pharmacobehavioral approach. The decision to medicate for obesity depends on good clinical judgment based on such considerations as body mass index; body composition; body fat dissociation; age; sex; and comorbid conditions, such as diabetes and hypertension. Several nonadrenergic agents and a serotonergic agent have FDA-approved indications for weight loss. Phenylpropanolamine is available over the counter. Clinical trials support the efficacy of fluoxetine and ephedrine or caffeine in producing weight loss, although these agents do not have FDA-approved indications for treatment for obesity. In addition, new agents are being developed or are anticipated for approval. The use of existing agents in combination and their use adjunctive to diet and behavioral approaches to obesity treatment are fertile areas for research. The expectant attention to this subject is demanded by the imperative that the health in one three people in the United States is adversely affected by obesity.
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PMID:Medicating the obese patient. 897 57

Oral phenylpropanolamine is commonly used to treat congestion and obesity. Clinicians often wonder what effect it has on blood pressure and whether they are safe in hypertensive patients. The purpose of our systematic review was to assess whether these drugs cause clinically meaningful elevations in pulse or blood pressure. English-language, randomized, placebo-controlled trials of oral phenylpropanolamine in adults with extractable data on pulse or blood pressure were studied. MEDLINE (1966-2003), Embase, the Cochrane library and reviewed article references were used as sources. Systolic (SBP) and diastolic blood pressure (DBP) and heart rate data were extracted. Additional extracted data included demographics, year, study design, study duration, drug dose and frequency, duration of washout and country. Study quality was assessed using the methods of Jadad and data were synthesized using a random effects model using weighted mean differences. In all, 33 trials reporting 48 treatment arms with 2165 patients were included. Phenylpropanolamine increased SBP 5.5 mmHg (95% CI: 3.1-8.0) and DBP 4.1 mmHg (95% CI: 2.2-6.0) with no effect on pulse. Patients with controlled hypertension were not at greater risk of blood pressure elevation. Immediate release preparations had greater effects on blood pressure than sustained release ones. Higher doses and shorter duration use also caused greater increases. Eighteen studies contained at least one treated subjects having blood pressure elevations > or =140/90 mmHg, an increase in SBP > or =15 mmHg or an increase in DBP > or =10 mmHg. In conclusion, phenylpropanolamine caused a small, but significant increase in systolic blood pressure. The effect was more pronounced with shorter-term administration, higher doses of medication and immediate release formulations.
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PMID:The impact of oral phenylpropanolamine on blood pressure: a meta-analysis and review of the literature. 1594 21

Over the past several years, the pharmacologic treatment of obesity has undergone changes in safety, efficacy, and therapeutic targeting. The prevalence of cardiac valvulopathy associated with treatment with phentermine, fenfluramine, and dexfenfluramine is now becoming clarified with the publication of longer-term studies. Phenylpropanolamine, a well-known over-the-counter appetite suppressant, was recently removed from the market in the United States because of an increased risk of hemorrhagic stroke in women. In contrast, two currently approved medications, sibutramine and orlistat, have been shown to be safe and moderately effective for weight loss with documented beneficial effects on cardiovascular risk factors. Three other drugs, bupropion, topiramate, and ciliary neurotrophic factor, are undergoing clinical trials for obesity based on empirical observations. Most promising are the advances in genetics and molecular biology that are beginning to elucidate new targets for controlling appetite and energy utilization. These therapeutic agents will likely herald a second generation of anti-obesity medications over the next decade.
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PMID:Obesity pharmacology: past, present, and future. 1703 90