Sibutramine

Aka: Sibutramine, Meridia

1. Background
   1. Sibutramine taken off the market October 2010 in United States due to risk of serious cardiovascular events
   2. Listed for historical purposes only
2. Contraindications
   1. Severe renal insufficiency
   2. Hepatic insufficiency
   3. Cerebrovascular Accident
   4. Hypertension
   5. Advanced cardiovascular disease
      1. Coronary Artery Disease
      2. Congestive Heart Failure
      3. Arrhythmias
   6. Hyperthyroidism
   7. Narrow-Angle Glaucoma
   8. Substance Abuse history
3. Dosing
   1. Continuous: Sibutramine 15 mg qd
   2. Intermittent (similar weight loss, less side effects)
      1. Weeks 1-12: Sibutramine 15 mg qd
      2. Weeks 19-30: Sibutamine 15 mg qd
      3. Weeks 37-48: Sibutramine 15 mg qd
      4. No medication taken in other weeks
      5. Wirth (2001) JAMA 286:1331-9
4. Efficacy: One year study
   1. Placebo group weight loss: 3.8 kg in 48 weeks
   2. Continuous Sibutramine: 7.9 kg in 48 weeks
   3. Intermittent Sibutramine: 7.8 kg in 48 weeks
   4. Wirth (2001) JAMA 286:1331-9
5. Mechanism
   1. Monoamine reuptake inhibitor Antidepressant
      1. Serotonin and Norepinephrine reuptake inhibitor
      2. Similar to Effexor
   2. Effects (dose dependent)
      1. Enhances satiety
      2. Increases energy expenditure (metabolic rate)
6. Adverse effects (Very similar to Effexor)
   1. Reduced adverse effects with intermittent treatment
   2. Common
      1. Diastolic Hypertension (2-10 mmHg increase)
         1. Optimize Blood Pressure control before use
      2. Tachycardia
      3. Insomnia
   3. Less common
      1. Headache
      2. Irritability
      3. Dry Mouth
      4. Dry Skin or rash
7. Drug Interactions: Mixed Noradrenergic-Serotonergic Agent
   1. SSRI
   2. Triptans (for Migraine Headache Management)
   3. Dihydroergotamine (DHE)
   4. Dextromethorphan
   5. Meperidine
   6. Pentazocine
   7. Fentanyl
   8. Lithium
   9. MAO inhibitors
   10. Guanethidine
   11. Tricyclic Antidepressants
   12. Alcohol
   13. Centrally acting stimulants or anorexiants