ABSTRACT
Since time immemorial, obesity has engulfed the mankind. It’s a pandemic. The prevalence is increasing by leaps and bound. Evidences date back to 30,000 BC. Earlier it was linked to wealth and status and it took a long time for it to be considered as a disease. This change in mind-set of the people occurred in mid-19th century. Different formulas for calculating the BMI (Body Mass Index) were invented which was different for the world and the South-East Asians. Slowly it became a topic for research among the scientific society and first priority was given to finding out the cause of obesity. It could not be pointed down to one as many factors were found to contribute to the menace of obesity. Age, gender, genetics, environment, food habits, various co-morbid conditions and the list of contributing factors is endless. Studies done at the molecular level have shown that various cytokines like TNF, Interleukins, Monocyte Chemoattractant Protein, adipokines, etc., have been implicated in the pathogenesis of obesity. The first line in the management of obesity is to take preventive measure. Those who have started to develop the disease should undergo a few non-pharmacological treatment options like lifestyle modification, change in food habits and behavioural therapy. Initially drugs like fenfluramine and sibrutramine were developed. With newer researches coming up more safer and consistent molecules like Tesofensin have been found and undergoing trial. If not benefited by medical treatment the last option what remains for the patient is bariatric surgery but they are too costly for general population to afford. Finally, it is best seen that it is wise enough to follow the saying “Prevention is better than cure” for a disease with such a vast etiology.
ABSTRACT
Sibutramine is an anorectic that has been banned since 2010 due to cardiovascular safety issues. However, counterfeit drugs or slimming products that include sibutramine are still available in the market. It has been reported that illegal sibutramine-contained pharmaceutical products induce cardiovascular crisis. However, the mechanism underlying sibutramine-induced cardiovascular adverse effect has not been fully evaluated yet. In this study, we performed cardiovascular safety pharmacology studies of sibutramine systemically using by hERG channel inhibition, action potential duration, and telemetry assays. Sibutramine inhibited hERG channel current of HEK293 cells with an IC50 of 3.92 muM in patch clamp assay and increased the heart rate and blood pressure (76 Deltabpm in heart rate and 51 DeltammHg in blood pressure) in beagle dogs at a dose of 30 mg/kg (per oral), while it shortened action potential duration (at 10 muM and 30 muM, resulted in 15% and 29% decreases in APD50, and 9% and 17% decreases in APD90, respectively) in the Purkinje fibers of rabbits and had no effects on the QTc interval in beagle dogs. These results suggest that sibutramine has a considerable adverse effect on the cardiovascular system and may contribute to accurate drug safety regulation.
Subject(s)
Animals , Dogs , Rabbits , Action Potentials , Blood Pressure , Cardiovascular System , Counterfeit Drugs , Heart Rate , HEK293 Cells , Inhibitory Concentration 50 , Pharmaceutical Preparations , Pharmacology , Purkinje Fibers , TelemetryABSTRACT
A obesidade é um grave problema de saúde pública, com prevalência crescente em níveis epidêmicos. Tratamento farmacológico é uma das abordagens terapêuticas, mas deve ser precedido de mudança de hábitos alimentares e prática regular de atividades físicas. Há preocupação com o uso não racional de medicamentos anorexígenos, independente da condição de doença. O estudo avaliou as dispensações destes psicotrópicos realizadas em 2009, Juiz de Fora, MG. Realizou-se a pesquisa em boletins de consumo, enviados mensalmente à VISA municipal, e em registros obtidos no SNGPC. De 7.759 notificações pesquisadas, 93,3% foram dispensadas por farmácias magistrais e 6,7% por drogarias. Daquele total, 55,4% foram de anfepramona, 33,1% de femproporex e 11,5% de mazindol. Com base em relatório da Anvisa, as três substâncias apresentaram consumo maior no município (DDD/mil hab/ano) do que no país como um todo, para o mesmo período. O profissional com maior número de receitas aviadas teve 3.535 dispensações. Todas foram dispensadas em farmácias, sendo 99,5% em um único estabelecimento. O cenário mostra a dispensação de anorexígenos como problema relevante de saúde coletiva e indica a necessidade de reavaliação dos critérios de monitoramento de sua prescrição, dispensação e consumo.
Obesity is a serious public health issue of epidemic proportions. Although drug therapy is one of the therapeutic approaches, it should be preceded by a change in eating habits along with regular exercise. This study assessed prescription of such drugs in 2009, in Juiz de Fora, Minas Gerais, Brazil. Data were collected from consumption bulletins sent monthly to the municipal sanitary surveillance agency (VISA), and from the Brazilian National Management System of Controlled Products. Of the 7,759 notifications assessed, 93.3% were dispensed by prescription pharmacies and 6.7% by drugstores. Of that total, 55.4% were for amphepramone, 33.1% for femproporex, and 11.5% for mazindol. The three drugs had a larger consumption rate in the municipality (daily defined dose/1,000 inhabitants/day) than in the country as a whole, during the period under study. The professional with the highest prescription rate was responsible for 3,535 prescriptions. All of these were dispensed by prescription pharmacies, a single outlet being responsible for 99.5% of these prescriptions. This scenario shows that anorectic psychotropic drug prescription is a relevant public health issue and the criteria for monitoring the prescription and consumption of these drugs should be re-evaluated.
Subject(s)
Humans , Appetite Depressants/therapeutic use , Obesity/drug therapy , Psychotropic Drugs/therapeutic use , Brazil , Cities , Cross-Sectional Studies , Drug Prescriptions/statistics & numerical data , Retrospective StudiesABSTRACT
OBJECTIVES: The International Narcotics Control Board released its 2005 annual report, highlighting the Brazil population as one of the largest consumers of anorectics. In Brazil, the National Health Surveillance Agency issued the resolution RDC 58/2007 in order to control the prescription and sale of such drugs. In Belém, the biggest city in the Brazilian Amazon region, this resolution came into force in 2008, leading to inspections of drugstores and magistral pharmacies. The aim of this work was to evaluate the consumption of psychotropic anorectic drugs and the impact of RDC 58/2007 on the prescription and dispensing of anorectics in drugstores and magistral pharmacies in Belém. METHODOLOGY: A retrospective quantitative and descriptive study was conducted of records from the Municipal Department of Health Surveillance of Belém, for 2005 to 2008. The differences in findings were regarded significant when p < 0.05. RESULTS: A total of 1,641 balance sheets of drugstores and magistral pharmacies were analyzed. Amfepramone was the most dispensed medication, followed by fenproporex and mazindol. The highest consumption of anorectics occurred in magistral pharmacies. In 2008, there was a significant reduction in dispensing of anorectics, in drugstores as well as in magistral pharmacies. CONCLUSIONS: This study showed that there was a decrease in the dispensing of anorectics after RDC 58/2007 came into force, and that the magistral pharmacies dispensed more of these drugs. This resolution is a remarkable tool in health control, where it is of great benefit to public health and contributes substantially to the rational use of medicines in Brazil.
OBJETIVOS: O International Narcotics Control Board publicou em 2005 sua pesquisa anual que demonstrou que a população brasileira são um dos maiores consumidores de anorexígenos. No Brasil, a Agência Nacional de Vigilância Sanitária publicou a resolução RDC 58/2007 com o objetivo de controlar a prescrição e comercialização deste tipo de medicamento. Em Belém, a maior cidade da Amazônia brasileira, esta resolução entrou em vigor em 2008, levando à inspeções em drogarias e farmácias. Este trabalho propõe avaliar o consumo de psicotrópicos anorexígenos e o impacto da RDC 58/2007 na prescrição e dispensação de anorexígenos nas drogarias e farmácias magistrais de Belém. METODOLOGIA: foi realizado um estudo retrospectivo, quantitativo e descritivo, com dados coletados do Departamento de Vigilância Sanitária de Belém, de 2005 a 2008. Os dados foram considerados quando p < 0,05. RESULTADOS: Um total de 1.641 balanços foram analisados oriundos de drogarias e farmácias magistrais. Anfepramona foi o medicamento mais dispensado, seguido do femproporex e manzidol. O maior consumo de anorexígenos ocorreu nas farmácias magistrais. Em 2008, houve uma redução significativa na dispensação de anorexígenos, tanto em drogarias quanto em farmácias magistrais. CONCLUSÕES: Este estudo demonstrou que houve uma diminuição na dispensação de anorexígenos após a entrada em vigor da RDC 58/2007, e as farmácias magistrais foram responsáveis por um elevado número na dispensação destes medicamentos. Esta resolução é um marco divisor no controle sanitário, para enorme benefício da saúde pública, contribuindo substancialmente para o uso racional de medicamentos no Brasil.
Subject(s)
Appetite Depressants , Health Surveillance , Diethylpropion , MazindolABSTRACT
Desde o ano passado, tem-se presenciado a polêmica sobre a proibição de medicamentos usados no tratamento da obesidade. Neste artigo, os autores pretendem mostrar os evidentes conflitos de interesses envolvidos na discussão e a manipulação de opinião pelos defensores da manutenção dos medicamentos. Acham que esse poderio daindústria farmacêutica em coaptar lideranças médicas não tem limites éticos. Muitos desses médicos se prestam ao papel de utilizar seu prestígio e sua capacidade de liderança para defender o ponto de vista da indústria, em evidente e condenável promiscuidade. Declaram os autores não serem contra a associação da indústria da área de saúde commédicos, mas a decência ética nessa cooperação deve prevalecer.
Since last year, one has witnessed the controversy regarding the ban of medications used for obesity treatment. In this article we intend to expose the obvious conflicts of interests enrolled on its discussion and the manipulation of opinion exerted by the defenders of the drugs continuity. We believe the power from the pharmaceutical industries tocraft and persuade the medical representatives beholds no ethical limits. And for many of such doctors, playing that role by lending their prestige and leadership to defend the industries? interests and points of view, it is a clear and reprehensible act of promiscuity. We are not against an association of the health industry with doctors. But wheneversuch cooperation happens to be, ethics and decency should prevail.
ABSTRACT
A study was conducted on 22,158 special B prescriptions (notificações B) containing amphetamine-type anorectic drugs or benzodiazepines, obtained from compounding pharmacies or drugstores located in the city of Natal, RN, Brazil. The data obtained were compared with those from other Brazilian cities. Results showed that compounding pharmacies dispensed 85.4 percent of the prescriptions, indicating that these pharmacies filled out nearly 10 times more of these prescriptions than did the drugstores. The majority (83.5 percent) of B prescriptions issued for the compounding pharmacies were for women, where the female/male patient ratio ranged from 7.1/1.0 for mazindol to 10.3/1.0 for amfepramone. Similar results were obtained for the benzodiazepines with ratios of 1.9/1.0 for clonazepam to 15.6/1.0 for oxazepam. Omissions and mistakes were present in the B prescriptions, including missing information about the patient (in 49.6 percent of the documents) or about the pharmacies or drugstores (50.4 percent). There were cases where the name and/or CRM of the physician was lacking. It was noted that one medical doctor made out 1855 B prescriptions within one year. The same patient's name appeared on 138 prescriptions, and the same RG (identification card number) was present in 125 others. Comparison of Natal's data with those of several other Brazilian cities disclosed a striking similarity throughout Brazil, from Pelotas - Rio Grande do Sul State to Belem-Para State, revealing a practically identical medical/pharmaceutical behavior. This pattern of prescription/dispensation of amphetamine-type substances mostly to women for weight loss is therefore for cosmetic reasons. Consequently, there is an urgent need for an ethical review of this behavior.
Foram examinadas 22.158 notificações B contendo substâncias anoréticas tipo-anfetamina ou de benzodiazepínicos, obtidas de drogarias e de farmácias de manipulação. Os dados foram comparados com os de outras cidades do Brasil, obtendo-se uma visão nacional sobre o assunto. Os achados mostraram que as farmácias de manipulação, dispensaram 85,4 por cento das notificações, ou seja, as farmácias de manipulação atenderam cerca de 10 vezes mais do que as drogarias. A maioria (83,5 por cento) das notificações B nas farmácias de manipulação eram destinadas às mulheres sendo a relação entre pacientes femininos/masculinos de 7,1/1,0 no caso do mazindol e de 10,3/1,0 para a anfepramona. Dados semelhantes foram obtidos para os benzodiazepínicos: relação de 1,9/1,0 para o clonazepam até 15,6/1,0 para o oxazepam. Falhas e erros gritantes foram também observados no preenchimento das notificações B: ausência de dados de pacientes (em 49,6 por cento dos documentos), do fornecedor (50,4 por cento) etc. Houve casos de notificações sem o nome ou CRM do médico e um único médico prescreveu 1.855 notificações B; o nome de uma mesma compradora apareceu em 138 notificações e um mesmo RG em 125 outras. A comparação destes achados com os de outras cidades mostrou uma surpreendente semelhança, ao longo do país, desde Pelotas-RS até Belém-PA; evidenciando um padrão de comportamento médico/farmacêutico praticamente idêntico. Este padrão de prescrição para mulheres destina-se mais para uma finalidade cosmética (perda de peso) do que para uma real necessidade terapêutica. É necessária uma revisão ética sobre este problema, que também tem sido observado e igualmente criticado em vários países.
Subject(s)
Appetite Depressants , Benzodiazepinones , Drug Prescription of Special Control , Drug Prescriptions/statistics & numerical data , Brazil , Obesity/rehabilitation , Technology, PharmaceuticalABSTRACT
Recently, obesity has become a worldwide public health concern and the use of anorectic drugs has drastically increased. In this study, sibutramine and phendimetrazine, representative marketed anorectics, were repeatedly administered per os on a daily basis into C57BL/6 mice and the effects of these drugs on food intakes, body weight changes and gene expression profiles were monitored for up to following 7 days. Methamphetamine, which has a potent anorectic effect, was used as a positive control. Anorectic effects were sustained only for two days by phendimetrazine or methamphetamine, but for six days by sibutramine. The modulations of gene expressions in the hypothalamus and the striatum were investigated using microarrays on day 2 and day 7 post-administration, which corresponded to the anorectic period and a return of appetite respectively, for all three drugs tested. Differences in overall gene expression profiles in the stratum on day 2 for sibutramine and phendimetrazine seems to reflect difference between the two in terms of the onsets of drug tolerance. According to microarray findings, the Ankrd26 gene appears to have an important anorectic role, whereas the up-regulation of the olfaction system appeared to be involved in the drug tolerance of anorectics. The microarray data presented in this study demonstrates the usefulness of gene expression analysis for gathering information on the efficacy and safety of anorectic drugs.
Subject(s)
Animals , Mice , Appetite , Appetite Depressants , Body Weight Changes , Cyclobutanes , Drug Tolerance , Gene Expression , Gene Expression Profiling , Hypothalamus , Methamphetamine , Morpholines , Obesity , Public Health , Smell , Transcriptome , Up-RegulationABSTRACT
A new plaster of Chinese materia medica,Xiaoshitie Plaster,is used to treat externally the internal disease through the navel application therapy method(giving medicine by trans- dermal absorption).It possesses the functions of invigoration the spleen and regulating the stomach-energy,promoting digestion and relieving dyspepsia,and is used for anorectic symp- tom in children.The investigation on clinical curative effect on 173 cases indicated that the total effective rate is up to 89.3%.It especially suited to anorectic symptom in children with asthenia of the spleen and stomach-energy.The effective rate is 93.94% and no toxicity and side-effect were observed.