Matching articles for "weight loss"

Table: GLP-1 and GIP/GLP-1 Receptor Agonists for Chronic Weight Management (online only)

   
The Medical Letter on Drugs and Therapeutics • August 5, 2024;  (Issue 1708)
...
View the Table: GLP-1 and GIP/GLP-1 Receptor Agonists for Chronic Weight Management
Med Lett Drugs Ther. 2024 Aug 5;66(1708):e1-2 | Show Full IntroductionHide Full Introduction

A New Indication for Semaglutide (Wegovy)

   
The Medical Letter on Drugs and Therapeutics • April 29, 2024;  (Issue 1701)
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy) has been approved by the FDA to reduce the risk of major adverse cardiovascular events (MACE) in adults with established...
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy) has been approved by the FDA to reduce the risk of major adverse cardiovascular events (MACE) in adults with established cardiovascular disease (CVD) and either obesity or overweight. Semaglutide is the first drug to be approved for cardiovascular risk reduction in this population. It is also approved in a lower-dose injectable formulation as Ozempic and in an oral formulation as Rybelsus (see Table 1).
Med Lett Drugs Ther. 2024 Apr 29;66(1701):66-7 | Show Full IntroductionHide Full Introduction

Tirzepatide (Zepbound) for Chronic Weight Management

   
The Medical Letter on Drugs and Therapeutics • December 25, 2023;  (Issue 1692)
The injectable glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide, which was approved by the FDA as Mounjaro for treatment of type 2 diabetes in...
The injectable glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide, which was approved by the FDA as Mounjaro for treatment of type 2 diabetes in 2022, has now been approved as Zepbound (Lilly) for chronic weight management in adults who have a BMI ≥30 kg/m2 or a BMI ≥27 kg/m2 and at least one weight-related comorbidity. The injectable GLP-1 receptor agonists liraglutide (Saxenda) and semaglutide (Wegovy) are approved for chronic weight management in patients ≥12 years old.
Med Lett Drugs Ther. 2023 Dec 25;65(1692):205-7 | Show Full IntroductionHide Full Introduction

In Brief: Semaglutide (Wegovy) for Weight Loss in Children

   
The Medical Letter on Drugs and Therapeutics • February 20, 2023;  (Issue 1670)
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy), which was approved by the FDA in 2021 for chronic weight management in adults, has now been approved for chronic weight...
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy), which was approved by the FDA in 2021 for chronic weight management in adults, has now been approved for chronic weight management in children ≥12 years old with an initial BMI in the ≥95th percentile for age and sex.Semaglutide is also available as Ozempic and Rybelsus for treatment of type 2 diabetes in adults.
Med Lett Drugs Ther. 2023 Feb 20;65(1670):31-2 | Show Full IntroductionHide Full Introduction

Drugs and Devices for Weight Management

   
The Medical Letter on Drugs and Therapeutics • May 30, 2022;  (Issue 1651)
Adults with a body mass index (BMI) between 25 and 29.9 kg/m2 are considered overweight. Those with a BMI ≥30 are considered obese. The initial recommendation for any weight loss effort is to achieve a...
Adults with a body mass index (BMI) between 25 and 29.9 kg/m2 are considered overweight. Those with a BMI ≥30 are considered obese. The initial recommendation for any weight loss effort is to achieve a 5-10% reduction in weight, which has been associated with a reduction in the risk of developing type 2 diabetes, hypertension, and dyslipidemia. Diet, exercise, and behavior modification are the preferred methods for losing weight, but long-term weight maintenance can be difficult. Several drugs and devices are FDA-approved for weight reduction and maintenance of weight loss.
Med Lett Drugs Ther. 2022 May 30;64(1651):81-8 | Show Full IntroductionHide Full Introduction

Comparison Table: Some FDA-Approved Drugs for Weight Management (online only)

   
The Medical Letter on Drugs and Therapeutics • May 30, 2022;  (Issue 1651)
...
View the Comparison Table: Some FDA-Approved Drugs for Weight Management
Med Lett Drugs Ther. 2022 May 30;64(1651):e89-91 | Show Full IntroductionHide Full Introduction

Setmelanotide (Imcivree) for Rare Genetic Forms of Obesity (online only)

   
The Medical Letter on Drugs and Therapeutics • July 26, 2021;  (Issue 1629)
The FDA has approved setmelanotide (Imcivree – Rhythm), a subcutaneously injected melanocortin 4 (MC4) receptor agonist, for chronic weight management in patients ≥6 years old with obesity due...
The FDA has approved setmelanotide (Imcivree – Rhythm), a subcutaneously injected melanocortin 4 (MC4) receptor agonist, for chronic weight management in patients ≥6 years old with obesity due to pro-opiomelanocortin (POMC) deficiency, proprotein subtilisin/kexin type 1 (PCSK1) deficiency, or leptin receptor (LEPR) deficiency.
Med Lett Drugs Ther. 2021 Jul 26;63(1629):e3-4 | Show Full IntroductionHide Full Introduction

Semaglutide (Wegovy) for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • July 12, 2021;  (Issue 1628)
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide, previously approved by the FDA as Ozempic to treat type 2 diabetes and to reduce the risk of major adverse cardiovascular events...
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide, previously approved by the FDA as Ozempic to treat type 2 diabetes and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, has now been approved in a higher dose as Wegovy (Novo Nordisk) for chronic weight management in adults with or without type 2 diabetes who have a body mass index (BMI) ≥30 kg/m2 or a BMI ≥27 kg/m2 and ≥1 weight-related comorbidity (e.g., hypertension, dyslipidemia). An oral formulation of semaglutide (Rybelsus) has been available since 2019 for treatment of type 2 diabetes, but it is not approved for weight management. Liraglutide (Saxenda), another subcutaneously injected GLP-1 receptor agonist, was approved for chronic weight management in 2015.
Med Lett Drugs Ther. 2021 Jul 12;63(1628):106-8 | Show Full IntroductionHide Full Introduction

Plenity for Weight Management

   
The Medical Letter on Drugs and Therapeutics • May 17, 2021;  (Issue 1624)
Plenity (Gelesis), a nonsystemic oral superabsorbent hydrogel formulation of cellulose and citric acid is now available. It was cleared by the FDA in 2019 to aid in weight management together with diet...
Plenity (Gelesis), a nonsystemic oral superabsorbent hydrogel formulation of cellulose and citric acid is now available. It was cleared by the FDA in 2019 to aid in weight management together with diet and exercise in overweight and obese adults (BMI of 25-40 kg/m2). It is classified by the FDA as a device because the contents of the capsule are not absorbed systemically. Plenity is the first ingested, transient, space-occupying hydrogel to be marketed in the US and the only weight management treatment available by prescription for patients with a BMI of 25-30 kg/m2, regardless of comorbidities. Low-dose orlistat (Alli) has been available over the counter for patients with a BMI ≥25 kg/m2 for years.
Med Lett Drugs Ther. 2021 May 17;63(1624):77-8 | Show Full IntroductionHide Full Introduction

Semaglutide (Ozempic) for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • April 5, 2021;  (Issue 1621)
In recently published clinical trials, once-weekly subcutaneous injection of the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide (Ozempic – Novo Nordisk), which is FDA-approved for treatment...
In recently published clinical trials, once-weekly subcutaneous injection of the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide (Ozempic – Novo Nordisk), which is FDA-approved for treatment of type 2 diabetes and to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, has reduced body weight significantly in patients with and without type 2 diabetes when given in addition to lifestyle intervention. Liraglutide (Saxenda), another GLP-1 receptor agonist, has been FDA-approved for chronic weight management since 2015.
Med Lett Drugs Ther. 2021 Apr 5;63(1621):53-4 | Show Full IntroductionHide Full Introduction

Drugs for Atrial Fibrillation

   
The Medical Letter on Drugs and Therapeutics • September 9, 2019;  (Issue 1580)
Treatment of atrial fibrillation includes anticoagulation, rate control, and rhythm control. US guidelines were recently...
Treatment of atrial fibrillation includes anticoagulation, rate control, and rhythm control. US guidelines were recently updated.
Med Lett Drugs Ther. 2019 Sep 9;61(1580):137-44 | Show Full IntroductionHide Full Introduction

Diet, Drugs, Devices, and Surgery for Weight Management

   
The Medical Letter on Drugs and Therapeutics • June 4, 2018;  (Issue 1548)
Adults with a body mass index (BMI) between 25 and 29.9 kg/m2 are considered overweight. Those with a BMI ≥30 are considered obese. The initial recommendation for any weight loss effort is to achieve a...
Adults with a body mass index (BMI) between 25 and 29.9 kg/m2 are considered overweight. Those with a BMI ≥30 are considered obese. The initial recommendation for any weight loss effort is to achieve a 5-10% reduction in weight, which has been associated with a reduction in the risk of developing type 2 diabetes, hypertension, and dyslipidemia. Diet, exercise, and behavior modification are the preferred methods for losing weight, but long-term weight maintenance can be difficult. Several drugs are FDA-approved for weight reduction and maintenance (see Table 1), and procedures such as endoscopic placement of dilated balloons have produced beneficial short-term results (see Table 2), but bariatric surgery has been the most effective intervention for sustainable long-term weight loss and reduction of obesity-related comorbidities.
Med Lett Drugs Ther. 2018 Jun 4;60(1548):91-8 | Show Full IntroductionHide Full Introduction

Comparison Table: Some FDA-Approved Drugs for Weight Management (online only)

   
The Medical Letter on Drugs and Therapeutics • June 4, 2018;  (Issue 1548)
...
View the Comparison Table: Some FDA-Approved Drugs for Weight Management
Med Lett Drugs Ther. 2018 Jun 4;60(1548):e98-100 | Show Full IntroductionHide Full Introduction

Drugs for GERD and Peptic Ulcer Disease

   
The Medical Letter on Drugs and Therapeutics • January 15, 2018;  (Issue 1538)
Gastroesophageal reflux disease (GERD) is the most frequent GI condition encountered in the outpatient setting; it affects about 20% of the US population. Heartburn and regurgitation are the classic...
Gastroesophageal reflux disease (GERD) is the most frequent GI condition encountered in the outpatient setting; it affects about 20% of the US population. Heartburn and regurgitation are the classic symptoms of GERD.
Med Lett Drugs Ther. 2018 Jan 15;60(1538):9-16 | Show Full IntroductionHide Full Introduction

Obalon Balloon System - Another Gastric Balloon for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • June 19, 2017;  (Issue 1523)
The FDA has approved the Obalon Balloon System (Obalon), a swallowable intragastric gas-filled balloon device, to facilitate weight loss in adults with a body mass index (BMI) of 30-40 kg/m2 who have not...
The FDA has approved the Obalon Balloon System (Obalon), a swallowable intragastric gas-filled balloon device, to facilitate weight loss in adults with a body mass index (BMI) of 30-40 kg/m2 who have not been able to lose weight through diet and exercise. Two other gastric balloon devices, ReShape and Orbera, were approved earlier.
Med Lett Drugs Ther. 2017 Jun 19;59(1523):102-3 | Show Full IntroductionHide Full Introduction

In Brief: Phentermine (Lomaira) for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • December 5, 2016;  (Issue 1509)
The FDA has approved Lomaira (KVK Tech), an 8-mg tablet formulation of phentermine that can be taken up to three times daily before meals, as an adjunct to lifestyle modifications for weight loss. It is only...
The FDA has approved Lomaira (KVK Tech), an 8-mg tablet formulation of phentermine that can be taken up to three times daily before meals, as an adjunct to lifestyle modifications for weight loss. It is only approved for short-term use (a few weeks) in adults with a body mass index (BMI) ≥30 kg/m2, or with a BMI ≥27 kg/m2 in addition to a weight-related comorbidity such as hypertension, dyslipidemia, or diabetes. Phentermine has been available alone and in combination with topiramate for years.1

Lomaira was approved by the FDA under an abbreviated new drug application (ANDA) and is considered a generic drug. Its approval was based on the results of earlier phentermine trials. No studies are available comparing the efficacy and safety of Lomaira to standard doses of phentermine or to any other drug approved for weight loss.

Like other sympathomimetic amines approved for weight loss, Lomaira is classified as a schedule IV controlled substance. All sympathomimetics can increase heart rate, raise blood pressure, and cause nervousness and insomnia.2 Phentermine is contraindicated for use in patients with cardiovascular disease, hyperthyroidism, glaucoma, or a history of drug abuse, and in pregnant women. It should not be used while taking, and for 14 days after stopping, a monoamine oxidase (MAO) inhibitor because of the risk of hypertensive crisis.

  1. Diet, drugs, and surgery for weight loss. Med Lett Drugs Ther 2015; 57:21.
  2. SZ Yanovski and JA Yanovski. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014; 311:74.


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Med Lett Drugs Ther. 2016 Dec 5;58(1509):158 | Show Full IntroductionHide Full Introduction

AspireAssist - A New Device for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • August 29, 2016;  (Issue 1502)
The FDA has approved AspireAssist (Aspire Bariatrics), a weight-loss device that permits patients to drain a portion of their stomach contents through a gastrostomy tube into a toilet after each meal. It is...
The FDA has approved AspireAssist (Aspire Bariatrics), a weight-loss device that permits patients to drain a portion of their stomach contents through a gastrostomy tube into a toilet after each meal. It is approved for long-term use in combination with lifestyle modifications in adults ≥22 years old who have a body mass index (BMI) of 35 to 55 and have not been able to achieve and maintain weight loss with nonsurgical therapy.
Med Lett Drugs Ther. 2016 Aug 29;58(1502):109-10 | Show Full IntroductionHide Full Introduction

Maestro Rechargeable System for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • April 25, 2016;  (Issue 1493)
The FDA has approved the Maestro Rechargeable System (EnteroMedics), a subcutaneously implanted device, for use in adults who have not been able to lose weight with a weight loss program within the past 5...
The FDA has approved the Maestro Rechargeable System (EnteroMedics), a subcutaneously implanted device, for use in adults who have not been able to lose weight with a weight loss program within the past 5 years and who have a body mass index (BMI) of 40 to 45, or a BMI ≥35 and at least one obesity-related comorbidity.
Med Lett Drugs Ther. 2016 Apr 25;58(1493):54-5 | Show Full IntroductionHide Full Introduction

Racemic Amphetamine Sulfate (Evekeo) for ADHD

   
The Medical Letter on Drugs and Therapeutics • September 28, 2015;  (Issue 1478)
The FDA has approved racemic amphetamine sulfate (Evekeo – Arbor) for oral treatment of attention-deficit/hyperactivity disorder (ADHD) in children ≥3 years old. It was also approved for treatment of...
The FDA has approved racemic amphetamine sulfate (Evekeo – Arbor) for oral treatment of attention-deficit/hyperactivity disorder (ADHD) in children ≥3 years old. It was also approved for treatment of narcolepsy in patients ≥6 years old and for short-term treatment of obesity in patients ≥12 years old.
Med Lett Drugs Ther. 2015 Sep 28;57(1478):137-8 | Show Full IntroductionHide Full Introduction

ReShape and Orbera - Two Gastric Balloon Devices for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • August 31, 2015;  (Issue 1476)
The FDA has approved the ReShape Integrated Dual Balloon System (ReShape Medical) and the Orbera Intragastric Balloon System (Apollo Endosurgery) for up to 6 months of use in adults with a BMI of 30-40 who...
The FDA has approved the ReShape Integrated Dual Balloon System (ReShape Medical) and the Orbera Intragastric Balloon System (Apollo Endosurgery) for up to 6 months of use in adults with a BMI of 30-40 who have not been able to maintain weight loss with a weight loss program and, for ReShape, who have at least one obesity-related comorbidity. Both devices have been available in the European Union and elsewhere for years (20 years for Orbera). Three other devices, the LAP-Band, the Realize adjustable gastric band, and the Maestro Rechargeable System, are FDA-approved for long-term treatment of obesity.
Med Lett Drugs Ther. 2015 Aug 31;57(1476):122-3 | Show Full IntroductionHide Full Introduction

Liraglutide (Saxenda) for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • June 22, 2015;  (Issue 1471)
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide, previously approved by the FDA for treatment of type 2 diabetes as Victoza, has now also been approved at a higher dose as...
The injectable glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide, previously approved by the FDA for treatment of type 2 diabetes as Victoza, has now also been approved at a higher dose as Saxenda (Novo Nordisk) for chronic weight management in adults with a BMI ≥30, or a BMI ≥27 with a weight-related comorbidity such as hypertension, dyslipidemia, or diabetes.
Med Lett Drugs Ther. 2015 Jun 22;57(1471):89-90 | Show Full IntroductionHide Full Introduction

Diet, Drugs, and Surgery for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • February 16, 2015;  (Issue 1462)
Adults with a body mass index (BMI) between 25 and 29.9 kg/m2 are considered overweight. Those with a BMI ≥30 are considered obese. Losing even a small amount of weight and increasing physical activity...
Adults with a body mass index (BMI) between 25 and 29.9 kg/m2 are considered overweight. Those with a BMI ≥30 are considered obese. Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing weight, but long-term failure rates are high. Several drugs have been approved by the FDA for weight reduction, but adherence is poor, adverse effects are common, and patients usually regain the lost weight when the drug is stopped. Bariatric surgery can produce substantial weight loss and significantly reduce obesity-related comorbidities; long-term data on its safety are encouraging, but still limited. Guidelines for the management of overweight or obese adults have recently been published.
Med Lett Drugs Ther. 2015 Feb 16;57(1462):21-8 | Show Full IntroductionHide Full Introduction

Contrave - A Combination of Bupropion and Naltrexone for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • November 10, 2014;  (Issue 1455)
The FDA has approved a fixed-dose combination of the opioid receptor antagonist naltrexone (ReVia, and others) and the antidepressant and smoking cessation agent bupropion (Wellbutrin SR, Zyban, and...
The FDA has approved a fixed-dose combination of the opioid receptor antagonist naltrexone (ReVia, and others) and the antidepressant and smoking cessation agent bupropion (Wellbutrin SR, Zyban, and others), as Contrave (Orexigen/Takeda) for weight loss. The combination was approved for use as an adjunct to diet and increased physical activity in patients with a body mass index (BMI) ≥30 kg/m2 or a BMI ≥27 kg/m2 and one or more weight-related comorbidities such as hypertension, diabetes, or dyslipidemia. Naltrexone/bupropion is not a controlled substance.
Med Lett Drugs Ther. 2014 Nov 10;56(1455):112-4 | Show Full IntroductionHide Full Introduction

Two Drugs for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • September 3, 2012;  (Issue 1398)
In 2013 the FDA approved one new drug and a new combination of 2 old drugs as adjuncts to lifestyle changes for chronic weight management. Lorcaserin (lor-ca-SER-in; Belviq – Arena/Esai) is a selective...
In 2013 the FDA approved one new drug and a new combination of 2 old drugs as adjuncts to lifestyle changes for chronic weight management. Lorcaserin (lor-ca-SER-in; Belviq – Arena/Esai) is a selective serotonin 2C receptor agonist. Qsymia (Vivus) is a fixed-dose combination of the weight-loss drug phentermine and an extended-release (ER) formulation of topiramate. The new products are approved for use in obese patients (body mass index [BMI] of ≥30 kg/m2) and for patients who are overweight (BMI ≥27 kg/m2) and have one weight-related risk factor such as hypertension, dyslipidemia or type 2 diabetes.
Med Lett Drugs Ther. 2012 Sep 3;54(1398):69-71 | Show Full IntroductionHide Full Introduction

Diet, Drugs and Surgery for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • April 1, 2011;  (Issue 104)
...
Adults with a body mass index (BMI=kg/m2) of 25-<30 are considered overweight; those with a BMI of ≥30 are considered obese.
Treat Guidel Med Lett. 2011 Apr;9(104):17-22 | Show Full IntroductionHide Full Introduction

In Brief: Human Chorionic Gonadotropin (hCG) for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • February 21, 2011;  (Issue 1358)
A Medical Letter reader asked if human chorionic gonadotropin (hCG; Novarel, Pregnyl and others) has any value as an adjunct to diet, adding that it is widely used for this indication in his area. Normally...
A Medical Letter reader asked if human chorionic gonadotropin (hCG; Novarel, Pregnyl and others) has any value as an adjunct to diet, adding that it is widely used for this indication in his area. Normally secreted by the placenta during pregnancy, the main therapeutic use of this gonad-stimulating polypeptide, which is not absorbed from the GI tract, has been in the parenteral treatment of infertility.1 It has also been injected by male athletes as an undetectable stimulus to production of testosterone.2

Use of hCG as an adjunct to diet goes back to the 1950’s, when a British physician named Simeons recommended daily injections of the hormone combined with a 500 kcal diet, and such use came to be known as the Simeons method. One double-blind study after another throughout the second half of the 20th century found hCG to be worthless for weight loss or maintenance.3

1. Drugs for assisted reproduction. Treat Guidel Med Lett 2003; 1:89.

2. Performance-enhancing drugs. Med Lett Drugs Ther 2004; 46:57.

3. GK Sabine Lijesen et al. The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. Br J Clin Pharmacol 1995; 40:237.

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Med Lett Drugs Ther. 2011 Feb 21;53(1358):16 | Show Full IntroductionHide Full Introduction

In Brief: Sibutramine (Meridia) Withdrawn

   
The Medical Letter on Drugs and Therapeutics • November 1, 2010;  (Issue 1350)
The results of a postmarketing study of its cardiovascular safety have led to the removal of the weightloss drug sibutramine (Meridia) from the market in the US and Canada. It has also been withdrawn in Europe...
The results of a postmarketing study of its cardiovascular safety have led to the removal of the weightloss drug sibutramine (Meridia) from the market in the US and Canada. It has also been withdrawn in Europe and Australia, but remains on the market in many other countries. The study that led the FDA to ask Abbott Laboratories to withdraw the drug randomized 10,744 overweight patients with cardiovascular disease, diabetes or both to sibutramine or placebo for a mean duration of 3.4 years. The primary endpoint (non-fatal myocardial infarction, nonfatal stroke, cardiovascular death or resuscitation after cardiac arrest) occurred in 561 of 4906 patients (11.4%) taking sibutramine and in 490 of 4898 (10%) taking placebo (p = 0.02). Death from any cause occurred in 8.5% of the patients who took sibutramine and in 8.2% of those on placebo; this difference was not statistically significant.1

1. WP James et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med 2010; 363:905.

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Med Lett Drugs Ther. 2010 Nov 1;52(1350):88 | Show Full IntroductionHide Full Introduction

In Brief: Different Diets

   
The Medical Letter on Drugs and Therapeutics • March 23, 2009;  (Issue 1308)
A recent article in the New England Journal of Medicine confirms something that others, including The Medical Letter (Treat Guidel Med Lett 2008; 6:23), have been saying for years: no particular combination of...
A recent article in the New England Journal of Medicine confirms something that others, including The Medical Letter (Treat Guidel Med Lett 2008; 6:23), have been saying for years: no particular combination of protein, carbohydrate and fat in the diet offers any advantage in losing weight. This randomized 2-year trial followed 800 overweight and obese subjects on low fat/average protein, low fat/high protein, high fat/average protein, and high fat/high protein diets. Carbohydrate intake varied from 35% (in the high fat/high protein diet) to 65% (in the low fat/average protein diet). All patients were advised to undertake 90 minutes of moderate exercise per week and given a “caloric prescription” to produce a deficit of 750 kcal per day. Most participants lost weight in the first 6 months and regained some thereafter. There was no significant difference in weight loss between different diets and no indication that any particular diet was more pleasant or less painful than any other. Average weight loss at the end of the trial was 4 kg among the remarkably high 80% of subjects who completed the trial, and 9 kg among those who also attended two thirds of the counseling sessions offered to the participants (FM Sacks et al, N Engl J Med 2009; 360:859).

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Med Lett Drugs Ther. 2009 Mar 23;51(1308):24 | Show Full IntroductionHide Full Introduction

Treatment of Peptic Ulcers and GERD

   
The Medical Letter on Drugs and Therapeutics • August 1, 2008;  (Issue 72)
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. Most duodenal and other gastric ulcers are caused by the gram-negative bacillus Helicobacter...
Peptic ulcers caused by treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) are mainly gastric ulcers. Most duodenal and other gastric ulcers are caused by the gram-negative bacillus Helicobacter pylori. Gastroesophageal reflux disease (GERD) is caused by gastric acid reflux into the esophagus. Drugs that suppress gastric acid production are the primary treatment for GERD and peptic ulcers.
Treat Guidel Med Lett. 2008 Aug;6(72):55-60 | Show Full IntroductionHide Full Introduction

Diet, Drugs and Surgery for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • April 1, 2008;  (Issue 68)
Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing...
Losing even a small amount of weight and increasing physical activity can prevent some of the complications of obesity, particularly type 2 diabetes. Diet and exercise are the preferred methods for losing weight but are associated with high long-term failure rates. Drugs may help some patients, but all currently available drugs for weight reduction have drawbacks. Gastric surgery can produce marked weight loss in the severely obese, but long-term data on safety are limited.
Treat Guidel Med Lett. 2008 Apr;6(68):23-7 | Show Full IntroductionHide Full Introduction

In Brief: Herbal Warning

   
The Medical Letter on Drugs and Therapeutics • February 11, 2008;  (Issue 1279)
The FDA recently advised health care professionals and consumers not to use a number of dietary supplements found to contain the phosphodiesterase-5 inhibitor sildenafil (Viagra) or an analog of the drug...
The FDA recently advised health care professionals and consumers not to use a number of dietary supplements found to contain the phosphodiesterase-5 inhibitor sildenafil (Viagra) or an analog of the drug (www.fda.gov). Although the effects of sildenafil may be noticeable (in men), the presence of other, possibly more toxic adulterants in dietary supplements may be more difficult or impossible to detect.

Other drugs previously found in dietary supplements have included lovastatin (Mevacor, and others), estrogen, alprazolam (Xanax, and others), indomethacin (Indocin, and others) and warfarin (Coumadin, and others). Aristolochic acid in Chinese herbal weight loss products caused acute renal failure in about 100 women in Belgium; at least 70 of them required dialysis or transplantation, and at least 18 developed urothelial cancer (Med Lett Drugs Ther 2002; 44:84).

Dietary supplements do not require FDA approval before marketing. The agency does have the power to remove mislabeled or adulterated products from store shelves, but the burden of discovery and proof is entirely on the government.

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Med Lett Drugs Ther. 2008 Feb 11;50(1279):9 | Show Full IntroductionHide Full Introduction

In Brief: Orlistat OTC for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • June 18, 2007;  (Issue 1263)
The FDA has approved over-the-counter (OTC) sale of the weight-loss drug orlistat (Xenical – Roche)1 as alli (GlaxoSmithKline), to be used in combination with a reduced-calorie, low-fat diet. Orlistat binds...
The FDA has approved over-the-counter (OTC) sale of the weight-loss drug orlistat (Xenical – Roche)1 as alli (GlaxoSmithKline), to be used in combination with a reduced-calorie, low-fat diet. Orlistat binds to gastric and pancreatic lipases, preventing absorption of about 30% of dietary fat with the 120-mg prescription dose, and 25% with the 60-mg OTC dose. A 16-week controlled trial of the OTC dose (60 mg 3 times daily with meals) in overweight, not obese, patients (average BMI 26.8) on a reduced-calorie, low-fat diet found that patients taking the drug lost 1.15 kg more than those taking placebo.2

Orlistat causes flatulence with oily spotting, loose stools, fecal urgency and occasional incontinence in 20-40% of patients on a low-fat diet; these effects presumably would be more frequent and more severe with a higher fat intake or self-prescription of higher-thanrecommended doses. The drug also interferes with absorption of fat-soluble vitamins (A, D, E, K); the manufacturer recommends that patients also take a multivitamin supplement at bedtime. Orlistat can increase the anticoagulant effect of warfarin and may interfere with the absorption of other drugs.

A “starter pack” of 90 capsules of alli (60 mg each) costs $62.99, compared to $224.64 for 90 capsules of Xenical (120 mg each).3

1. Orlistat for obesity. Med Lett Drugs Ther 1999; 41:55.

2. JW Anderson et al. Low-dose orlistat effects on body weight of mildly to moderately overweight individuals: a 16 week, double-blind, placebo-controlled trial. Ann Pharmacother 2006; 40:1717.

3. Cost based on information from drugstore.com (June 11, 2007).

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Med Lett Drugs Ther. 2007 Jun 18;49(1263):49 | Show Full IntroductionHide Full Introduction

In Brief: Exenatide (Byetta) for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • March 13, 2006;  (Issue 1230)
Patients may be asking about reports in the lay press that exenatide (Byetta - Med Lett Drugs Ther 2005; 47:45), a synthetic peptide that stimulates release of insulin from pancreatic beta cells, has been used...
Patients may be asking about reports in the lay press that exenatide (Byetta - Med Lett Drugs Ther 2005; 47:45), a synthetic peptide that stimulates release of insulin from pancreatic beta cells, has been used by diabetics and non-diabetics to lose weight. Approved by the FDA to improve glycemic control in patients with type 2 diabetes not controlled by metformin, a sulfonylurea or both, it is given by subcutaneous injection before the morning and evening meals. In clinical trials, some diabetic patients treated with the drug lost weight. No data are available on use in non-diabetics. Exenatide slows gastric emptying and promotes satiety, which is presumably the mechanism of weight loss.

Patients should be warned that exenatide has some adverse effects. Hypoglycemia has occurred when the drug was added to a sulfonylurea but not when it was added to metformin. The risk of hypoglycemia in non-diabetics is unknown. Exenatide often causes nausea, which can be severe, and vomiting. Diarrhea can also occur. Because the drug slows gastric emptying, it can decrease the rate and extent of absorption of other drugs such as antibiotics and oral contraceptives; oral drugs should be taken at least one hour before exenatide.

Perhaps the greatest concern with off-label use of exenatide for weight loss is that 3 times the human dose given to pregnant animals slowed fetal growth and produced skeletal and other developmental abnormalities. The FDA classified it as category C (risk cannot be ruled out) for use during pregnancy. For diabetics and non-diabetics, pregnant or not, exenatide's long-term safety is unknown.
Med Lett Drugs Ther. 2006 Mar 13;48(1230):21 | Show Full IntroductionHide Full Introduction

In Brief: New Dietary Guidelines

   
The Medical Letter on Drugs and Therapeutics • January 31, 2005;  (Issue 1201)
The US Department of Health and Human Services, in conjunction with the US Department of Agriculture, has released the latest update of its Dietary Guidelines (www.health.gov). The emphasis this time is on...
The US Department of Health and Human Services, in conjunction with the US Department of Agriculture, has released the latest update of its Dietary Guidelines (www.health.gov). The emphasis this time is on weight loss through calorie restriction and exercise. A low-fat intake is recommended; a low-carbohydrate diet is not. Fruits, vegetables and whole grains are encouraged. A review of Diet, Drugs and Surgery for Weight Loss appeared in the December 2003 issue of Treatment Guidelines from The Medical Letter.
Med Lett Drugs Ther. 2005 Jan 31;47(1201):12 | Show Full IntroductionHide Full Introduction

Diet, Drugs and Surgery for Weight Loss

   
The Medical Letter on Drugs and Therapeutics • December 1, 2003;  (Issue 16)
The latest definitions of overweight and obesity are based on body mass index (BMI). The BMI is calculated by dividing the weight in kilograms by the square of the height in meters (kg/m2). More than half of...
The latest definitions of overweight and obesity are based on body mass index (BMI). The BMI is calculated by dividing the weight in kilograms by the square of the height in meters (kg/m2). More than half of American adults are considered overweight with a BMI of ≥25, and about one third are obese with a BMI of ≥30. All ages seem to be affected; the proportion of children and adolescents who are overweight has more than doubled in the past 25 years. There is no lack of effort to treat obesity: drugs, diets and programs to change lifestyle are the basis for a large and flourishing industry. The frequent failure of diet and drug treatment sometimes leads to recommendations for surgery, usually restricted to those with a BMI ≥40.
Treat Guidel Med Lett. 2003 Dec;1(16):101-6 | Show Full IntroductionHide Full Introduction