Appetite Suppressants as Adjuncts for Weight Loss

Evidence Summary Studies have estimated that 25 percent of men and 45 percent of women are trying to lose weight at any given time.1 Prescription weight loss medications may be appropriate for use in patients without comorbidities (e.g., hypertension, diabetes mellitus, hyperlipidemia) who have a body mass index of 30 kg per m2 or greater, and in patients with comorbidities who have a body mass index of 27 kg per m2 or greater.2 The effectiveness of appetite suppressants has been studied, but the optimal time for initiating therapy has not been clearly defined. Phentermine and diethylpropion are the only appetite suppressants approved by the U.S. Food and Drug Administration; sibutramine was voluntarily withdrawn by the manufacturer in 2010 because of data showing an increased risk of cardiovascular events.3 Phentermine and diethylpropion are contraindicated in patients with cardiovascular disease, moderate to severe hypertension, glaucoma, hyperthyroidism, a history of drug abuse, or hypersensitivity to sympathomimetic amines, and in those who have used a monoamine oxidase inhibitor within the previous 14 days. Recommendations from Others Clinical guidelines from the Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults support using appetite suppressants approved by the U.S. Food and Drug Administration in patients with a body mass index of 30 kg per m2 or greater if no obesity-related risk factors are present.