A recent letter to the editor in the New England Journal of Medicine (Nov. 1, 2007; 357:1873-74) from two Malaysian doctors talked about an increased risk for heart attacks in people taking appetite suppressants. That prompted us to do some research on diet drugs available in the US. We found one drug, sibutramine (brand name Meridia) particularly troubling. This drug was implicated by Malaysian doctors as the cause of an acute heart attack in an otherwise healthy 24-year-old woman.
This prescription drug has been on the market in the U.S. since 1998. Related to amphetamines, it enhances satiety by inhibiting the reuptake of two neurotransmitters, norepinephrine and serotonin.
If you’re taking it, your doctor may have warned you that Meridia can increase heart rate and blood pressure. About 5% of people who take the drug have to stop because of these side effects.
What your doctor may not tell you, though, is that the consumer health organization, Public Citizen, which publishes Worst Pills, Best Pills petitioned the Food and Drug Administration (FDA) to ban Meridia in the spring of 2002, based on reports of deaths and severe cardiac adverse reactions reported to the FDA. The FDA denied the petition. According to Public Citizen, the FDA acted against the better judgment of both the physicians who reviewed data on this drug for the FDA and the FDA’s external advisory committee by allowing this drug to remain on the market.
“Both the agency’s own doctors and its advisors are on record as saying that the benefits (loss of a few pounds in weight) do not outweigh the risks (increased blood pressure and thus increase risk for heart attack and stroke).”
Another diet drug also on Public Citizen’s “Do Not Use” list is phentermine (Adipex-P, Fastin) the surviving half of the notorious phen-fen combination of phentermine and fenfluramine that tended to cause serious complications, including leaky heart valves and pulmonary hypertension. (This was an off-label use, and after an FDA health advisory was issued, fenfluramine was removed from the market in 1997.)
Phentermine, however, remains on the market. It’s also in the amphetamine class, and can cause elevated blood pressure and increased heart rate, along with psychiatric symptoms. Phentermine also causes just slight weight loss and is known to be addictive.
Since they seem so risky for so little benefit, we wonder if these drugs remain on the market because of pressure on the FDA by drug companies.
As a consumer, it’s up to you, and hopefully your doctor, to know the risks of any drug you might take. Qualified experts think both Meridia and phentermine should be avoided. Their high risks are simply not worth their limited benefits.
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