Obezite, vücuda alınan ve harcanan enerjideki dengesizlik sonucu ortaya çıkan 20. yüzyılın en önemli kronik rahatsızlıklarından biridir. Özellikle de değişen yaşam koşullarıyla birlikte fiziksel aktivite azalması ve kalorili beslenme alışkanlıklarının artması sebebiyle obezite insidansı her geçen gün artmaktadır. Obezite derecesindeki artışa paralel olarak mortalite ve kardiyovasküler hastalık riskinin de arttığı bildirilmektedir. Özellikle de diyabet patogenezinde, obezite ve kilo artışı önemli risk faktörleri arasında yer almaktadır. Bu nedenle obezite tedavisi, obezitenin yol açtığı kronik hastalıkların gelişimi açısından da önem taşımaktadır. Yaşam tarzı değişikliklerinin yanı sıra, geçmişten bu yana obezite tedavisinde, uzun veya kısa vadede kullanılan birçok antiobezite ilacı bulunmakta ve bir kısmı ile ilgili faz çalışmaları hâlâ devam etmektedir. Bu ilaçlardan bazıları ise istenmeyen advers etkileri nedeni ile piyasadan çekilmiştir. Bu çalışmada, geçmişten günümüze obezite tedavisinde kullanılan ilaçların toksikolojik açısından değerlendirilmesi ve advers etkilerinin incelenmesi amaçlanmıştır.
Anahtar Kelimeler: Obezite; advers etki; zayıflama ilaçları; sibutramin; orlistat
Obesity is one of the most important chronic disorders of the 20th century, which is the result of the imbalance of the energy taken in the body and used. The incidence of obesity is increasing gradually, especially due to the changed physical conditions associated with lifestyle and high-calorie eating habits. In parallel, it is stated that the increase in the degree of obesity increases the risk of mortality and cardiovascular disease. Especially in the pathogenesis of diabetes, obesity and weight gain are important risk factors. Therefore, obesity treatment is also important for the development of chronic diseases caused by obesity. In addition to lifestyle changes, there have been many anti-obesity agents used in the long or short term in the treatment of obesity since the past, and some phase studies are still ongoing. Some of these drugs have been withdrawn from the market due to their unwanted adverse effects. The purpose of this review is to evaluate the toxicological aspects of the drugs used in the treatment of obesity and to investigate the adverse effects of these drugs.
Keywords: Obesity; adverse effect; weight loss medications; sibutramine; orlistat
- Halpern B, Oliveira ES, Faria AM, Halpern A, Melo ME, Cercato C, et al. Combinations of drugs in the treatment of obesity. Pharmaceuticals (Basel). 2010;3(8):2398-415. [Cross - ref] [PubMed] [PMC]
- Karakaya K, Baran E, Tüzün H, Göçmen L, Erata M, Arıkan İ, et al. [Research on perception of body weight in Turkey]. Akdağ R, editör. Turkiye Beden Ağırlığı Algısı Araştırması. Sağlık Bakanlığı Yayın No: 894. T.C. Turkiye Cumhuriyeti Sağlık Bakanlığı Sağlığın Geliştirilmesi Genel Müdürlüğü. Ankara: Anıl Matbaacılık Ltd Şti; 2012. p.16-8.
- World Health Organisation (WHO). Obesity and Overweight. WHO Official Website; 2018.
- Khan A, Raza S, Khan Y, Aksoy T, Khan M, Weinberger Y, et al. Current updates in the medical management of obesity. Recent Pat Endocr Metab Immune Drug Discov. 2012;6(2):117-28. [Crossref] [PubMed]
- World Health Organisation (WHO). Division of Noncommunicable Diseases Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation On Obesity. Geneva: WHO; 1997. p.79.
- Bray GA. A concise review on the therapeutics of obesity. Nutrition. 2000;16(10):953-60. [Crossref]
- Yen M, Ewald MB. Toxicity of weight loss agents. J Med Toxicol. 2012;8(2):145-52. [Crossref] [PubMed] [PMC]
- Tanakol R. [Orlistat in obesity treatment]. Turk J Endocrinol Metab. 2003;(Suppl 2):87-97.
- Jain SS, Ramanand SJ, Ramanand JB, Akat PB, Patwardhan MH, Joshi SR. Evaluation of efficacy and safety of orlistat in obese patients. Indian J Endocrinol Metab. 2011;15(2):99104. [Crossref] [PubMed] [PMC]
- Torgerson JS, Hauptman J, Boldrin MN, Sjöström L. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2003;27(1):155-61. [Crossref]
- Kujawska-Łuczak M, Musialik K, Szulińska M, Swora-Cwynar E, Kargulewicz A, Grzymisławska M, et al. The effect of orlistat versus metformin on body composition and insulin resistance in obese premenopausal women: 3-month randomized prospective open-label study. Arch Med Sci. 2017;13(4): 725-31. [Crossref] [PubMed] [PMC]
- Koca SS, Özkan Y, Akbulut H, Günay İ, Dönder E. [Decreased adinopectin level and effect of orlistat treatment in obesity]. Turkiye Klinikleri J Med Sci. 2006;26(2):126-31.
- Acharya NV, Wilton LV, Shakir SA. Safety profile of orlistat: results of a prescription-event monitoring study. Int J Obesity (Lond). 2006;30(11):1645-52. [Crossref] [PubMed]
- Xiao D, Shi D, Yang D, Barthel B, Koch TH, Yan B. Carboxylesterase-2 is a highly sensitive target of the antiobesity agent orlistat with profound implications in the activation of anticancer prodrugs. Biochem Pharmacol. 2013;85(3):439-47. [Crossref] [PubMed] [PMC]
- Allison DB, Gadde KM, Garvey WT, Peterson CA, Schwiers ML, Najarian T, et al. Controlled-release phentermine/topiramate in severely obese adults: a randomized controlled trial (EQUIP). Obesity (Silver Spring). 2011;20(2):330-42. [Crossref] [PubMed] [PMC]
- Wadden TA, Berkowitz RI, Silvestry F, Vogt RA, St John Sutton MG, Stunkard AJ, et al. The fen-phen finale: a study of weight loss and valvular heart disease. Obes Res. 1998;6(4): 278-84. [Crossref] [PubMed]
- Kang JG, Park CY, Kang JH, Park YW, Park SW. Randomized controlled trial to investigate the effects of a newly developed formulation of phentermine diffuse-controlled release for obesity. Diabetes Obes Metab. 2010;12(10):876-82. [Crossref] [PubMed]
- Kim HO, Lee JA, Suh HW, Kim YS, Kim BS, Ahn ES, et al. Postmarketing surveillance study of the efficacy and safety of phentermine in patients with obesity. Korean J Fam Med. 2013;34(6):298-306. [Crossref] [PubMed] [PMC]
- Stahl KA, Imperiale TF. An overview of the efficacy and safety of fenfluramine and mazindol in the treatment of obesity. Arch Fam Med. 1993;2(10):1033-8. [Crossref]
- Bray GA, Ryan DH. Update on obesity pharmacotherapy. Ann N Y Acad Sci. 2014;1311: 1-13. [Crossref] [PubMed]
- Catoira NP, Viale L, Di Girolamo G, Gonzalez C. New centrally acting agents for appetite control: from biological mechanisms to clinical efficacy. Curr Med Res Opin. 2014;30(6):961-9. [Crossref] [PubMed]
- Scientific conclusions and grounds for refusal presented by the European Medicines Agency: Overall summary of the scientific evaluation of Qsiva; 2013. p.10.
- FDA Center for Drug Evaluation and Research. Reference ID: 3160379. Summary Review for Regulatory Action Qsymia; 2013. p.18.
- Ioannides-Demos LL, Piccenna L, McNeil JJ. Pharmacotherapies for obesity: past, current, and future therapies. J Obes. 2011;2011: 179674. [Crossref] [PubMed] [PMC]
- Cheung BM, Cheung TT, Samaranayake NR. Safety of antiobesity drugs. Ther Adv Drug Saf. 2013;4(4):171-81. [Crossref] [PubMed] [PMC]
- Arterburn DE, Crane PK, Veenstra DL. The efficacy and safety of sibutramine for weight loss: a systematic review. Arch Intern Med. 2004;164(9):994-1003. [Crossref] [PubMed]
- Türk Eczacılar Birliği (TEB). Sibutramin İçeren Ürünlerin Satışının Durdurulması ve Toplatılmasına Yönelik Geri Çekme Duyurusu. Sayı: 006064. Ankara: 2010.
- Ali O. Sibutramine: a safety profile. Br J Cardiol. 2003;10:137-40.
- Nisoli E, Carruba MO. An assessment of the safety and efficacy of sibutramine, an antiobesity drug with a novel mechanism of action. Obes Rev. 2000;1(2):127-39. [Crossref] [PubMed]
- Kang JG, Park CY. Anti-obesity drugs: a review about their effects and safety. Diabetes Metab J. 2012;36(1):13-25. [Crossref] [PubMed] [PMC]
- Kokaçya MH, Şahpolat M, Kurhan F. [First manic episode induced by over the counter slimming drug that contains sibutramine]. J Mood Disorders. 2014;4(3):126-9. [Crossref]
- Kayar H, Utku S. [Disease of our time: obesity and its treatment]. Mersin Üniv Sağlık Bilim Derg. 2013;6(2):1-8.
- Aronne LJ, Tonstad S, Moreno M, Gantz I, Erondu N, Suryawanshi S, et al. A clinical trial assessing the safety and efficacy of taranabant, a CB1R inverse agonist, in obese and overweight patients: a high-dose study. Int J Obes (Lond). 2010;34(5):919-35. [Crossref] [PubMed]
- Hurren KM, Berlie HD. Lorcaserin: an investigational serotonin 2C agonist for weight loss. Am J Health Syst Pharm. 2011;68(21):2029-37 [Crossref] [PubMed]
- European Medicine Agency (EMA). Withdrawal of the Marketing Authorisation Application for Belviq (Lorcaserin). EMA; 2013. Document Number: EMA/309180/2013.
- Kim GW, Lin JE, Blomain ES, Waldman SA. Antiobesity pharmacotherapy: new drugs and emerging targets. Clin Pharmacol Ther. 2013;95(1):53-66. [Crossref] [PubMed] [PMC]
- Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med. 2010; 363(3):245-56. [Crossref] [PubMed]
- Manning S, Pucci A, Finer N. Pharmacotherapy for obesity: novel agents and paradigms. Ther Adv Chronic Dis. 2014,5(3):135-48. [Crossref] [PubMed] [PMC]
- Dias S, Paredes S, Ribeiro L. Drugs involved in dyslipidemia and obesity treatment: focus on adipose tissue. Int J Endocrinol. 2018;2018:2637418. [Crossref] [PubMed] [PMC]
- Hendricks EJ. Off-label drugs for weight management. Diabetes Metab Syndr Obes. 2017;1:223-34.
- Scott LJ. Liraglutide: a review of its use in the management of obesity. Drugs. 2015;75(8): 899-910. [Crossref] [PubMed]
- Mancini MC, de Melo ME. The burden of obesity in the current world and the new treatments available: focus on liraglutide 3.0 mg. Diabetol Metabol Syndr. 2017;9:44. [Crossref] [PubMed] [PMC]
- Astrup A, Rössner S, Van Gaal L, Rissanen A, Niskanen L, Al Hakim M, et al. Efects of liraglutide in the treatment of obesity: a randomised, double-blind, placebo-controlled study. Lancet. 2009;374(9701):1606-16. [Crossref]
- Ladenheim EE. Liraglutide and obesity: a review of the data so far. Drug Des Devel Ther. 2015;1867-75. [Crossref] [PubMed] [PMC]
- Jeong KH, Yoo BK. The efficacy and safety of liraglutide. Int J Clin Pharm. 2011;33(5):740-9. [Crossref] [PubMed]
- Coulter AA, Rebello CJ, Greenway FL. Centrally acting agents for obesity: past, present, and future. Drugs. 2018;78(11):1113-32. [Crossref] [PubMed]
- Appolinario JC, Bueno JR, Coutinho W. Psychotropic drugs in the treatment of obesity: what promise? CNS Drugs. 2004;18(10):629[Crossref] [PubMed]
- McElroy SL, Guerdjikova AI, Martens B, Keck PE Jr, Pope HG, Hudson JI. Role of antiepileptic drugs in the management of eating disorders. CNS Drugs. 2009;23(2):139-56. [Crossref] [PubMed]
- McElroy SL, Keck PE Jr. Obesity in bipolar disorder: an overview. Curr Psychiatry Rep. 2012;14(6):650-8. [Crossref] [PubMed]
- Gadde KM, Franciscy DM, Wagner HR 2nd, Krishnan KR. Zonisamide for weight loss in obese adults: a randomized controlled trial. JAMA. 2003;289(14):1820-5. [Crossref] [PubMed]
- Srivastava G, Apovian C. Future pharmacotherapy for obesity: new anti-obesity drugs on the horizon. Curr Obes Rep. 2018;7(2): 147-61. [Crossref] [PubMed]
- Wharton S, Serodio KJ. Next generation of weight management medications: implications for diabetes and CVD risk. Curr Cardiol Rep. 2015;17(5):35. [Crossref] [PubMed] [PMC]
- Hollander P. Anti-diabetes and anti-obesity medications: effects on weight in people with diabetes. Diabetes Spectr. 2007;20(3):159-65. [Crossref]
- Malin SK, Kashyap SR. Effects of metformin on weight loss: potential mechanisms. Curr Opin Endocrinol Diabetes Obes. 2014;21(5): 323-9. [Crossref] [PubMed]
- Jensterle Sever M, Kocjan T, Pfeifer M, Kravos NA, Janez A. Short-term combined treatment with liraglutide and metformin leads to significant weight loss in obese women with polycystic ovary syndrome and previous poor response to metformin. Eur J Endocrinol. 2014;170(3):451-9. [Crossref] [PubMed] [PMC]
- Erkekoğlu P, Baydar T, Şahin G. [Evaluation of obesity treatment approaches in geriatric group from atoxicological aspect-II: antiobesitic drugs]. Turkish Journal of Geriatrics. 2009;12(4):202-16.
- Igel LI, Sinha A, Saunders KH, Apovian CM, Vojta D, Aronne LJ. Metformin: an old therapy that deserves a new indication for the treatment of obesity. Curr Atheroscler Rep. 2016;18(4):16. [Crossref] [PubMed]
- de Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, et al. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ.2010;340:c2181. [Crossref] [PubMed] [PMC]
- Dunican KC, Adams NM, Desilets AR. The role of pramlintide for weight loss. Ann Pharmacother. 2010;44(3):538-45. [Crossref] [PubMed]
- Smith SR, Aronne LJ, Burns CM, Kesty NC, Halseth AE, Weyer C. Sustained weight loss following 12-month pramlintide treatment as an adjunct to lifestyle intervention in obesity. Diabetes Care. 2008;31(9):1816-23. [Cross - ref] [PubMed] [PMC]
- Ryan G, Briscoe TA, Jobe L. Review of pramlintide as adjunctive therapy in treatment of type 1 and type 2 diabetes. Drug Des Devel Ther. 2008;2:203-14. [Crossref]
- Riddle MC, Drucker DJ. Emerging therapies mimicking the effects of amylin and glucagonlike peptide 1. Diabetes Care. 2006;29(2):43549. [Crossref]
- Moretto TJ, Milton DR, Ridge TD, Macconell LA, Okerson T, Wolka AM, et al. Efficacy and tolerability of exenatide monotherapy over 24 weeks in antidiabetic drugnaive patients with type 2 diabetes: a randomized, double-blind, placebo-controlled, parallelgroup study. Clin Ther. 2008;30(8):1448-60. [Crossref] [PubMed]
- Bunck MC, Diamant M, Eliasson B, Cornér A, Shaginian RM, Heine RJ, et al. Exenatide affects circulating cardiovascular risk biomark ers independently of changes in body composition. Diabetes Care. 2010;33(8):1734-7. [Crossref] [PubMed] [PMC]
- Krentz AJ, Fujioka K, Hompesch M. Anti-obesity pharmacotherapy: the intercontinental regulatory divide. Drugs. 2015;75(9):931-3. [Crossref] [PubMed]
- Ioannides-Demos LL, Proietto J, Tonkin AM, McNeil JJ. Safety of drug therapies used for weight loss and treatment of obesity. Drug Saf. 2006;29(4):277-302. [Crossref]
- Afkhami-Ardekani M, Sedghi H. Effect of fluoxetine on weight reduction in obese patients. Indian J Clin Biochem. 2005;20(1):135-8. [Crossref] [PMC]
- Maheux P, Ducros F, Bourque J, Garon J, Chiasson JL. Fluoxetine improves insulin sensitivity in obese patients with non-insulindependent diabetes mellitus independently of weight loss. Int J Obes Relat Metab Disord. 1997;21(2):97-102. [Crossref]
- Ricca V, Mannucci E, Mezzani B, Moretti S, Di Bernardo M, Bertelli M, et al. Fluoxetine and fluvoxamine combined with individual cognitive-behaviour therapy in binge eating disorder: a one-year follow-up study. Psychother Psychosom. 2001;70(6):298-306. [Crossref]
- Melendez G, Serralde-Zúñiga AE, Garay AGG, Rodríguez-Carmona Y, Galicia CS. Flu oxetine for adult overweight or obese people. Cochrane Database Syst Rev. 2015;5. [Cross ref]
- Wurtman RJ, Wurtman JJ. Brain serotonin, carbohydrate-craving, obesity and depression. Obes Res. 1995;3 Suppl 4:477S-480S. [Crossref]
- Halford JC, Harrold JA, Lawton CL, Blundell JE. Serotonin (5-HT) drugs: effects on appetite expression and use for the treatment of obesity. Curr Drug Targets. 2005;6(2):201-13. [Crossref]
- Cangiano C, Laviano A, Del Ben M, Preziosa I, Angelico F, Casinco A, et al. Effects of oral 5-hydroxy-tryptophan on energy intake and macronutrient selection in non-insulin dependent diabetic patients. Int J Obes Relat Metab Disord. 1988;22(7):648-54. [Crossref]
- Ceci F, Cangiano C, Cairella M, Cascino A, Del Ben M, Muscaritoli M, et al. The effects of oral 5-hydroxytryptophan administration on feeding behavior in obese adult female subjects. J Neural Transm. 1989;76(2):109-17. [Crossref]
- Onakpoya IJ, Heneghan CJ, Aronson JK. Post-marketing withdrawal of anti-obesity medicinal products because of adverse drug reactions: a systematic review. BMC Med. 2016;14(1):191. [Crossref] [PMC]
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