Anorectic
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Anorectics, anorexigenics or appetite suppressants, are substances which reduce the desire to eat ("anorectic", from the Greek an- = "not" and oreg- = "extend, reach").
Used on a short term basis clinically to treat obesity, some appetite suppressants are also available over the counter. Drugs of this class are frequently stimulants of the phenethylamine family, related to amphetamine (speed). Amphatemines were widely issued to British soldiers during the First World War in order to suppress their appetites and thus ease the strain on the over-stretched logistics network. The German military experimented with a similar system in 1945, when food supplies were very short in Germany. Following the Second World War, amphetamines were re-directed for use on the civilian market. Indeed, amphetamine itself was sold commercially as an appetite suppressant until it was outlawed in most parts of the world in the late 1950s due to increasing exploitation of its stimulant properties ("abuse"). Many amphetamines produce side effects including addiction, tachycardia and hypertension, making prolonged unsupervised use dangerous.
Epidemics of fatal pulmonary hypertension and heart valve damage associated with anorectic agents have led to the withdrawal of products from the market. This was the case with aminorex in the 1960s, and again in the 1990s with fenfluramine (see: Fen-phen). Likewise, association of the related appetite suppressant phenylpropanolamine with hemorrhagic stroke led the FDA to request its withdrawal from the market in the United States in 2000, and similar concerns regarding ephedrine resulted in an FDA ban on its inclusion in dietary supplements, in 2004.
In spite of these precedents, numerous related compounds are still marketed today as appetite suppressants. These include phentermine (Fastin®, Adipex®, Ionamin® and others), diethylpropion (Tenuate®), phendimetrazine (Prelu-2®), benzphetamine (Didrex®) and others. Sibutramine (Meridia®, Reductil®) is a recent addition, which is used with orlistat by doctors to control obesity. The new cannabinoid receptor antagonist Rimonabant (Acomplia®) will be available in 2006.
References
- Abenhaim L, Moride Y, Brenot F, Rich S, Benichou J, Kurz X, Higenbottam T, Oakley C, Wouters E, Aubier M, Simonneau G, Begaud B. Appetite-Suppressant Drugs and the Risk of Primary Pulmonary Hypertension. N Engl J Med 1996;335:609. Fulltext (http://content.nejm.org/cgi/content/full/335/9/609). PMID 8692238.
- Fishman AP. Aminorex to Fen/Phen: An Epidemic Foretold. Circulation 1999;99:156. Fulltext (http://circ.ahajournals.org/cgi/content/full/99/1/156). PMID 9884392.
External links
- Questions and Answers about appetite suppressant medication treatment from the Medical College of Wisconsin (http://healthlink.mcw.edu/article/933126929.html)