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Obesity - Management
Which anti-obesity drug should I prescribe?

  • Orlistat is the anti-obesity drug of choice when drug treatment is considered to be appropriate in primary care.
    • The decision to use drug treatment should be made after discussing with the person the potential benefits and limitations of using orlistat, including the mode of action, adverse effects, and monitoring requirements (see Prescribing information for further information).
  • Sibutramine is no longer prescribable in the UK — its marketing authorization has been suspended by the European Medicines Agency.
Basis for recommendation
  • These recommendations are based on guidelines published by the National Institute for Health and Clinical Excellence [NICE, 2006b; NICE, 2008].
    • There is good evidence that orlistat is effective in improving weight loss compared with placebo [NICE, 2006b]. After 12 months the median weight loss with orlistat (in combination with a weight-reducing diet) was 5.4 kg (range 3.3 to 7.6 kg).
  • On 23 October 2008 the European Medicines Agency's (EMEA) Committee for Medicinal Products for Human Use (CMHP) recommended the suspension of the marketing authorisation for rimonabant because the benefits no longer outweigh the risks [EMEA, 2008].
    • Following the assessment of the available information on the benefits and risks of rimonabant, including data from studies completed since it was granted marketing authorisation, the CHMP confirmed that there is an approximate doubling of the risk of psychiatric disorders in obese or overweight people taking rimonabant compared to those taking placebo.
    • Prescribers should not issue any prescriptions for rimonabant and should review the treatment of anyone currently taking it.
  • On 21 January 2010 the EMEA recommended the suspension of the Marketing Authorisation for sibutramine because the benefits no longer outweigh the risks [EMEA, 2010].
    • Data from the SCOUT trial (designed to determine the impact of weight loss with sibutramine on cardiovascular problems in overweight and obese people; 10,000 participants enrolled for up to six years) showed an increased risk of non-fatal cardiovascular events such as stroke and heart attack with sibutramine compared with placebo. The EMEA also notes that the weight loss achieved with sibutramine is modest in comparison with that obtained with placebo and it is not clear if this effect on weight loss can be maintained when sibutramine treatment is stopped.
    • Prescribers should not issue any prescriptions for sibutramine, and should review the treatment of anyone currently taking it.

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