Slimming Products

Effects

Antiadiposita differ in their effects. They inhibit appetite or increase satiety, reduce the absorption of food components in the intestine or promote their utilization, increase energy metabolism and degrading metabolic processes. The ideal slimming agent would enable rapid, high and stable weight loss and at the same time be very well tolerated and applicable to all patient groups. Unfortunately, such a miracle drug is not currently on the market.

Indications

For the treatment of overweight and obesity (adiposity). Treatment should always be accompanied by dietary changes and increased physical activity.

1. approved active ingredients

Lipase inhibitors:

  • Orlistat (Xenical, generics, OTC preparations) is an active ingredient in the lipase inhibitor group used to treat overweight and obesity (BMI ≥ 28). It inhibits the digestion of fats in the intestine, which are not absorbed but excreted in the stool. Orlistat can be taken before, during, or up to 1 hour after meals. Meals should contain only a small amount of fat, otherwise adverse effects such as fatty stools, diarrhea, and abdominal pain may occur. Isolated cases of liver disease during treatment have been reported.

Serotonin agonists:

GLP-1 receptor agonists:

2nd approval revoked

Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSNRIs):

Cannabinoid receptor antagonists:

  • Rimonabant (Acomplia, off label). Cannabinoid receptor antagonists abolish the effects of the endocannabinoid system, which is physiologically activated by the endogenous ligand anandamide and by the intoxicant cannabis. The effects are largely opposite to those of cannabis. Cannabinoid receptor antagonists have appetite suppressant, antiadipose, and lipid-lowering effects and are used to treat overweight and obesity. Common adverse effects include psychiatric disorders such as depressive moods. The only representative of the drug group to date is rimonabant (Acomplia, Sanofi-Aventis) and was withdrawn from the market shortly after its introduction due to its poor risk-benefit ratio in 2008.

3. unapproved active substances (Switzerland).

Many other drugs can lower body weight but are not approved for the indications of overweight and obesity in many countries. Their weight-lowering effects may be useful for the approved indication, for example, diabetes mellitus or depression with concomitant obesity. However, because of adverse effects, it is questionable whether they should be prescribed off-label in medical treatment for the exclusive treatment of obesity. Sympathomimetics, amphetamines, and amphetamine-like:

Norepinephrine and dopamine reuptake inhibitors:

  • Bupropion (Zyban, Wellbutrin) is approved for the treatment of depression and smoking cessation. It increases the feeling of fullness and seems moderately effective.

Serotonin reuptake inhibitors:

Thyroid hormones:

  • The thyroid hormones levothyroxine and liothyronine have been used as slimming agents since the 19th century. They promote fat loss and increase basal metabolic rate. Problematic are the numerous adverse effects.

Histamine agonists:

  • Betahistine has an appetite suppressant effect and could be used as an antiadipositive in the future.

Antidiabetics:

  • Dipeptidyl peptidase-4 inhibitors such as vildagliptin (Galvus) and sitagliptin (Januvia) inhibit the degradation of incretins, promoting their effects.
  • Metformin (Glucophage, generics) has an antiadipose effect that is desirable in diabetics (type 2), who are often overweight.
  • Other antidiabetic drugs tend to cause more weight gain.

Newer antiepileptic drugs:

  • Topiramate (Topamax) is approved for the treatment of epilepsy and migraine prophylaxis and has an appetite suppressant effect. Its efficacy as an antiadipositive has been demonstrated but is limited by common adverse effects, such as drowsiness, fatigue, paresthesias, headache, dizziness, and nausea. Similarly, zonisamide (Zonegran).

Opioid antagonists:

  • Naltrexone (naltrexin) inhibits food intake. It is approved for medication support in the withdrawal treatment of formerly opiate-dependent patients. Loss of appetite is a common adverse effect. Naltrexone is also used off-label for other addictions. A combination with bupropion is approved in the United States; see naltrexone bupropion (Contrave).

Abuse

Because many drugs have antiadipose effects but are not approved for this indication, some patients misuse them to lose weight. This is true, for example, of thyroid hormones or sympathomimetics such as ephedrine and phenylpropanolamine, which are available as veterinary medications. The possible misuse must be taken into account in the pharmacy, as the uncontrolled use of such agents can lead to serious adverse effects, especially through interactions and in the case of contraindications. Another problem is posed by slimming products traded on the Internet that are laced with potent active ingredients. Swissmedic recently warned against the slimming product Zhen de Shou, which is sold over the Internet and contains sibutramine.

4. alternative antiadiposita

Numerous herbal and other alternative medicine remedies are available as drugs, medical devices or food supplements. The efficacy of these remedies has generally not been reliably demonstrated. Herbal remedies may also cause adverse effects, such as caffeine, tobacco (smoking), ephedra, or herbal laxatives. Dietary fiber and dietary fiber:

Chitosan:

  • Chitosan is a ß-1,4 polymer of D-glucosamine and N-acetyl-D-glucosamine from crustacean shell, according to the manufacturer, binds fats in food and thus inhibits them from being absorbed into the body. For detailed information, see the article Chitosan.

Caffeine and caffeine drugs:

Herbal sympathomimetics:

  • Ephedra and its constituent ephedrine inhibit appetite and promote thermogenesis. They appear to be conditionally effective, are not approved for this indication in many countries, and may cause serious adverse effects (cardiovascular).Common is the combination with caffeine.

Others (selection):