Abstract
Sympathomimetic agents have a poor history of long-term success in the treatment of obesity. From earlier experiences with amphetamine and its analogs, to more recent drugs with direct effects on adrenergic receptors or indirect effects from release of catecholamines or inhibition of reuptake, cardiovascular toxicity (strokes and cardiac arrhythmias) has been the major concern. These concerns also extended to food supplements containing ephedra alkaloids and may require consideration for current supplements containing the sympathomimetic drug, synephrine.
Highlights
Sibutramine is the most recent drug with sympathomimetic activity that has been recognized by regulatory agencies as having cardiovascular adverse effects that may outweigh its potential value as a weightloss drug
The European Medicines Agency took definitive action on January 21, 2010 in advising against the continued prescribing of the drug, and Abbott Laboratories suspended sales of the drug in Europe [1]. This action was prompted by a preliminary evaluation of results from the Sibutramine Cardiovascular OUTcome (SCOUT) trial reported by the United States FDA [2]
The FDA has not imposed a ban on the drug but has obtained a change in the boxed warning label to contraindicate its use in patients with a history of cardiovascular disease and in all individuals over 65 years of age. These regulatory actions were prompted by an early review of the SCOUT trial [3] that revealed an incidence of cardiovascular events of 11.4% in patients receiving sibutramine compared to 10% in those receiving placebo
Summary
From earlier experiences with amphetamine and its analogs, to more recent drugs with direct effects on adrenergic receptors or indirect effects from release of catecholamines or inhibition of reuptake, cardiovascular toxicity (strokes and cardiac arrhythmias) has been the major concern. Sibutramine is the most recent drug with sympathomimetic activity that has been recognized by regulatory agencies as having cardiovascular adverse effects that may outweigh its potential value as a weightloss drug.
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