Anorectics (Appetite Suppressants)

Anorectics, anorexigenics or appetite suppressants, are substances which reduce the desire to eat. Used on a short term basis clinically to treat obesity, some appetite suppressants are also available over the counter. Drugs of this class are frequently stimulants of the phenethylamine family, related to amphetamine (speed). Indeed, amphetamine itself was sold commercially as an appetite suppressant until it was outlawed in most parts of the world in the late 1950s due to increasing exploitation of its stimulant properties ("abuse"). Many amphetamines produce side effects including addiction, tachycardia and hypertension, making prolonged unsupervised use dangerous.

Numerous related compounds are still marketed today as appetite suppressants. These include phenetermine (Fastin®, Adipex®, Ionamin® and others), diethylpropion (Tenuate®), phendimetrazine (Prelu-2®), benzphetamine (Didrex®) and others. Sibutramine (Medaria®, Reductil®) is a recent addition, which is used with orlistat by doctors to control obesity.

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Benzphetamine (brand name: Didrex) is an anti-obesity drug marketed under this brand in the USA by Pharmacia. Benzphetamine is used as a short term adjunct in management of exogenous obesity. It is closely related to amphetamine.

Cationary Notes about Diet Pills:

Epidemics of fatal pulmonary hypertension and heart valve damage associated with anorectic agents have led to the withdrawal of products from the market. This was the case with aminorex in the 1960s, and again in the 1990s with fenfluramine (see: Fen-phen). Likewise, association of the related appetite suppressant phenylpropanolamine with hemorrhagic stroke led the FDA to request its withdrawal from the market in the United States in 2000, and similar concerns regarding ephedrine resulted in an FDA ban on its inclusion in OTC products in 2004.

The Story of Fen-phen

Fen-phen was an anti-obesity medication (an anorectic) which consisted of two drugs: fenfluramine and phentermine.

After reports of heart valve disease and pulmonary hypertension in women who had been undergoing treatment with fen-phen, the FDA requested its withdrawal from the market in 1997.

The action was based on findings from doctors who had evaluated patients taking these two drugs with echocardiograms, a special procedure that can test the functioning of heart valves. These findings indicated that approximately 30 percent of patients who were evaluated had abnormal echocardiograms, even though they had no symptoms. This is a much higher than expected percentage of abnormal test results.

In July 1997, researchers at the Mayo Clinic and Mayo Foundation reported 24 cases of rare valvular disease in women who took the "fen-phen" combination therapy. FDA alerted medical doctors that it had received nine additional reports of the same type, and requested all health care professionals to report any such cases to the agency’s MedWatch program or to the respective pharmaceutical manufacturers.

Subsequently, FDA received 66 additional reports of heart valve disease associated mainly with "fen-phen." There were also reports of cases seen in patients taking only fenfluramine or dexfenfluramine. FDA requested that the manufacturers of fenfluramine and dexfenfluramine stress the potential risk to the heart in the drugs’ labeling and patient package inserts. As of 1997, the FDA continued to receive reports of cardiac valvular disease in persons who have taken these drugs.

As of 2004, Fen-phen is no longer widely available.

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