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Articoli sull'obesità

Weight management and current options in pharmacotherapy: Orlistat and sibutramine.

BACKGROUND: Chronic obesity is associated with various cardiovascular disorders, inlcuding diabetes, dyslipidemia, and hypertension. Pharmacotherapy with antiobesity agents is an important management strategy in conjuction with lifestyle interventions. OBJECTIVE: This articles describes the pharmacologic management of obesity, concentrating on orlistat and sibutramine. METHODS: Relevant articles were identified through a MEDLINE search (1966-February 2002) using the terms obesity, overweight, weight loss, antiobesity drugs, orlistat and sibutramine. The search for efficacy trials was limited to randomized controlled studies of >6 months duration. Also included in the review were relevant references cited in the bibliographies of identified articles, news reports, and the authors' own data. RESULTS: Orlistat reduces fat absorption by inhibiting gastrointestinal lipases. In randomized, controlled trials of up to 2 years' duration, orlistat plus a hypocaloric diet produced significantly greater weigth loss than placebo (P<0.001). In the maintenance phase, patients taking orlistat had less weight regain than did placebo recipients. The weight reduction with orlista was also associated with a significant improvement in control of cardiovascular risk factors (P<0.05). Unlike orlistat, sibutramine works by suppressing appetite; its efficacy, however, was similar to that of orlistat in the idetnified clinical trials. Orlistat was associated primarily with gastrointestinal side effects. Use of orlistat was associated with minimal drug interactions, except with cyclosporine, with which it should not be taken. Sibutramine was also well tolerated, although it may cause dry mouth, anorexia, and insomnia, and should be used with caution in patients at risk for cardiovascular disease.