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Sibutramine can help manage obesity, but it may not be appropriate for patients with significant cardiovascular disease

Currently, an estimated one-third of the U.S. population is obese, and 50 percent of Americans may be obese by 2020. Clinical trials of sibutramine—a medication that has been approved for the long-term management of obesity—in obese individuals have demonstrated significant weight loss and better weight maintenance than placebo, as well as reduction in fat mass. However, because the drug increases heart rate and blood pressure, it may not be applicable for use in obese patients with significant cardiovascular disease or uncontrolled hypertension.

Blood pressure and heart rate should be regularly monitored in all patients taking sibutramine, according to Walker S. Carlos Poston, Ph.D., M.P.H., of the University of Missouri, Kansas City, and John P. Foreyt, Ph.D., of Baylor College of Medicine. They reviewed clinical efficacy and safety trials of the drug and examined its appropriateness for special populations ranging from minorities and people with diabetes to patients with binge eating disorders. Their work was supported in part by the Agency for Healthcare Research and Quality (HS11282).

Obesity is defined as a body mass index (BMI; weight in kg/height in m2) of 30 or more, for example, a 5'5" woman weighing 180 pounds or more or a 5'11" man weighing 215 pounds or more. Obesity is a serious public health problem, since it boosts the risk of developing heart disease, diabetes, some cancers, osteoarthritis, and other disorders. Sibutramine helps weight loss by increasing feelings of fullness and satisfaction, due to the medication's selective effect on the availability of the neurotransmitters, serotonin and noradrenaline. It has established general safety and efficacy in long-term trials with clinically approved doses of 10 mg and 15 mg. However, the researchers concluded that data are insufficient at this time to determine its appropriateness for use in special populations, such as people with binge eating disorders.

See "Sibutramine and the management of obesity," by Drs. Poston and Foreyt, in Expert Opinion on Pharmacotherapy 5(3), pp. 633-642, 2004.

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