The medications most commonly used in our practice when appropriate are appetite suppressants and fat blockers.
Phentermine (Adipex P, Ionamin, Fastin) is the safe half of the phen-fen combination. Fenfluramine has been taken off the market and was never recommended in our practice because of it’s know risks. Phentermine has the best supportive literature for long-term usage and effectiveness. It is available in once a day strengths of 15, 30 and 37.5 mg, and three a day 8 mg. Side effects include rapid heart rate, dry mouth, constipation, and stimulation.
Diethylpropion (Tenuate) tends to have less but similar side effects, and is available in once daily doses of 75 mg, or 25 mg three times a day.
Sibutramine (Meridia) is chemically similar to antidepressants with side effects similar to them, most commonly dry mouth, insomnia, nausea, and headache. Daily doses of 5, 10 and 15 mg are available.
Orlistat (Xenical) is a fat blocker that keeps up to 30% of dietary fat from being absorbed into the body. Dosage is 120 mg up to 3 times a day taken ½ hour before meals containing fat. Common side effects include cramping, diarrhea, gas, and uncontrollable oily leakage.
Long term studies of weight loss medications used as part of a complete program along with diet, exercise and behavior modification have shown statistically significant sustained weight loss for 3 months (diethylpropion, PPA), 12 months (sibutramine), 2 years (orlistat), to 3 years (phentermine). In one study of phentermine, 20% of the patients lost 15% of their weigh at 3 years.