Which medications in the drug class CNS Stimulants, Anorexiants are used in the treatment of Obesity?

Updated: Mar 20, 2018
  • Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

CNS Stimulants, Anorexiants

Anorexiants are administered to manage obesity. Indications include weight loss and maintenance of weight loss, in conjunction with a reduced-calorie diet, specifically in patients who have an initial body mass index (BMI) of 30 or more (obese) or a BMI of 27 or more (overweight) and other risk factors (eg, diabetes mellitus, dyslipidemia, hypertension).

Adrenergic agonists that release tissue stores of epinephrine, causing subsequent alpha- and/or beta-adrenergic stimulation, have provided benefits to patients with obesity. Response to therapy should be evaluated by week 12. If a patient has not lost at least 5% of baseline body weight, stimulants should be discontinued, as it is unlikely that the patient will achieve and sustain clinically meaningful weight loss with continued treatment.

Lorcaserin (Belviq, Belviq XR)

Lorcaserin is indicated as an adjunct to a reduced-calorie diet and exercise for long-term weight management in patients with an initial BMI of ≥30 (obese) or in those with a BMI of ≥27 (overweight) who have at least 1 weight-related comorbid condition (eg, hypertension, dyslipidemia, type 2 diabetes mellitus).

The exact mechanism of action of lorcaserin is unknown, but this agent is thought to decrease food consumption and promote satiety by selectively activating 5-HT2C receptors on anorexigenic pro-opiomelanocortin neurons located in the hypothalamus.

Phentermine/topiramate (Qsymia)

This low-dose combination of phentermine, a sympathomimetic amine anorectic, and extended-release topiramate, an antiepileptic drug that possibly suppresses appetite and enhances satiety. The drug combination is indicated as an adjunct to a reduced-calorie diet and increased physical activity for long-term weight management in adults.

Phentermine (Adipex P, Lomaira)

Phentermine is a sympathomimetic amine that increases the release and reuptake of norepinephrine and dopamine. Its anorexiant effect occurs as a result of satiety-center stimulation in hypothalamic and limbic areas of the brain.

As a pharmacologic component of a comprehensive weight-reduction program (including behavioral modification, caloric restriction, and exercise), phentermine is intended for patients with an initial BMI of ≥30 (obese). It is also appropriate for patients with a BMI of ≥27 (overweight) who have other risk factors (eg, diabetes, hyperlipidemia, hypertension).

Phentermine is indicated for patients aged ≥16 y. It is available in capsules, tablets, and orally disintegrating tablets. This medication is contraindicated for use in pregnant women.

Diethylpropion

Diethylpropion is indicated for use as a short-term adjunct in the management of obesity. It is a sympathomimetic amine that reduces appetite, an effect that appears to be secondary to CNS effects. It is available in a 24-hour controlled-release formulation that should be taken at midmorning. It is indicated for patients aged ≥16 y.

Phendimetrazine (Bontril PDM)

Phendimetrazine is indicated for use as a short-term adjunct in the management of obesity in patients aged ≥17 y. It is a sympathomimetic amine that reduces appetite, an effect that appears to be secondary to CNS effects.

This agent is available in a 24-hour slow-release 105 mg capsule, which should be taken in the morning 30-60 minutes before breakfast. It is also available in 17.5-35 mg tablets, which should be taken 2 or 3 times daily and an hour before a meal. The maximum recommended dose is 70 mg TID. Phendimetrazine is contraindicated during pregnancy.

Benzphetamine (Regimex)

Benzphetamine is a sympathomimetic amine that reduces appetite, an effect that appears to be secondary to CNS effects. It is used as a short-term adjunct to caloric restriction in exogenous obesity. It is indicated for use in patients aged ≥12 y; the maximum dose is 50 mg TID. This medication is contraindicated during pregnancy.


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