Appetite Suppressants

Appetite suppressants cover a range of compounds, from the decongestant phe-nylpropanolamine (often available without prescription), to powerful amphetamine analogues (chemical variants). Most are stimulant, although one, fenfluramine, is quite sedative. As with the amphetamines, patterns of use and abuse vary a great deal, from chronic daily ingestion of a therapeutic dose to binge or spree use of large quantities. As a general rule, the more amphetamine- like the appetite suppressant, the more likely it is to be abused.

Trying to stop the use of appetite suppressants may be difficult for abusers, because of withdrawal symptoms such as tiredness, dysphoria (discomfort), or frank depression. These problems and growing doubts about sustained effectiveness (for their original dietary purposes) have led many doctors to cease prescribing them.

In the early to mid-1990's, two prescription diet drugs, fenfluramine (often taken with phentermine and popularly known as fen-phen) and dexfenfluramine (Redux), grew in popularity. These drugs stimulated production of the brain chemical serotonin, creating a feeling of satiety. Stories in the news media hailed fen-phen and Redux as a miracle cure for obesity. By 1996, millions of prescriptions had been written for the diet pills.

In 1997, reports of heart valve disease in women taking fen-phen or Redux began to surface. The New England Journal of Medicine published a study by doctors at the Mayo Clinic that reported twenty-four women taking fen-phen developed symptomatic heart valve disorders. At the same time, the Food and Drug Administration issued a Public Health Advisory reporting the Mayo Clinic findings and reporting that it had received reports of thirty-six cases of unusual heart valve abnormalities in women ages 30 to 72 taking fenfluramine or dexfenfluramine.

By September 1997, the drugs dexfenfluramine and fenfluramine were withdrawn from the U.S. market by their manufacturer, American Home Products. In December 1999, the company agreed to compensate thousands of people who took either drug in a $3.75 billion dollar settlement of a nationwide class action suit.

Since 1997, subsequent studies have confirmed a causal link between fenfluramines and valve disorders. There is also persuasive evidence of a significant duration effect. In a 1998 study of more than 17,000 obese patients in the United Kingdom, 92 percent of the patients with symptomatic valve disorders had used fenfluramines for more than 3 months. For those who took fen-phen or Redux for less than 3 months, the risk of heart valve disorders appears to be minimal.

(SEE ALSO: Iatrogenic Addiction; Obesity)

BIBLIOGRAPHY

Ator, N. A., & Griffiths, R. R. (1987). Self-administration of barbiturates and benzodiazepines: A review. Pharmacology, Biochemistry, and Behavior, 57, 391398.

Clayton, R. R., Voss, H. L., & Loscuito, L. A. (1987). Main findings: 19855 National Household Survey on Drug Abuse. Rockville, MD: National Institute on Drug Abuse.

Cohen, M. R.(1999). Medication Errors. Washington, D.C.: American Pharmaceutical Association.

Connolly, H. M., Crary, J. L., & McGoon M. (1997). Valvular heart disease associated with fenfluramine-phentermine. New England Journal of Medicine, 337, 581-588.

Gardin, J. M., Schumacher, D., Constantine, G., Davis, K. D., Leung, C., & Reid C. L. (2000). Valvular abnormalities and cardiovascular statistics following exposure to dexfenfluramine or phentermine. Journal of the American Medical Association, 283, 1703-1709.

Graham, D. J., & Green L.(1997). Further cases of valvular heart disease associated with fenfluramine-phentermine. New England Journal of Medicine, 337, 635.

Jick, H., Vasilakis, C., & Weinrauch L. A. (1998). A population-based study of appetite-suppressant drugs and the risk of cardiac-valve regurgitation. New England Journal of Medicine, 339, 719-724.

Wesson, D. R. & SMITH, D. E. (1977). Barbiturates: Use, misuse, and abuse. New York: Human Sciences Press.

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