Pharmacological treatment of obesity and overweight and adverse effects related to drug use

Abstract

Obesity is a global epidemic with serious health and economic consequences. In Bulgaria, 62 % of men, 51 % of women, and 30 % of children of school age are overweight and obese. The pharmacological treatment of obesity should be only a part of an overall strategy of treating the disease. Currently, drug therapy is recommended only in patients with a BMI of ≥ 30 kg/m2, or with overweight and BMI ≥ 27 kg/m2 when associated with concomitant diseases (e.g., hypertension, type 2 diabetes mellitus). Despite the availability of a large number of preparations, due to serious adverse effects, only a small part have shown sufficiently good results, and have been approved for long-term use. From 2010 Sibutramine is no longer licensed for clinical use, due to concerns about its cardiovascular safety. Results of the SCOUT study demonstrated that long-term administration of the drug resulted in a significant increase in the incidence of non-fatal myocardial infarction and stroke. Headache is the only adverse effect of Lorcaserin, witch frequency is more than 5% according to placebo. Depression and anxiety appear with less frequency. In 2012 is recorded a new combination of Topiramate/Phentermin, and 2014 combination of Naltrexone / Bupropione. European Commission for the control of drugs used in humans (CHMP) gave a positive opinion for the combination Topiramate / Phentermin, due to mental and cardiovascular risk over time. Regarding another combination (naltrexone/bupropion SR), there is a warning about rare but severe psychological side effects.