Medications To Help Control Your Appetite

As physicians, we are called upon many times to help people control their appetite, and one of the good reasons to go to a physician is that you can receive a prescription if necessary.

There are only three medications that are FDA-approved for weight loss and there are many drugs that you can use for weight loss that are FDA-approved, but they’re not necessarily approved for the indication of weight loss. So they’re sort of used as the term we call “off-label”. So many physicians who are not really specialists in weight loss, they’re not Bariatric physicians, probably don’t have the expertise to use these other drugs, but the three medications that are available that are FDA-approved are Phentermine, Phendimetrazine, Diethylpropion, also known as Tenuate.

These medications have been around for fifty years. And they were used a lot in their early days, and the thinking was that back in the fifties when these drugs were introduced, the FDA wasn’t really doing long-term studies. They were really only doing short-term studies, and what they were concerned about during those days was merely safety. So once these drugs were found to be safe, they stopped testing. They said, “Okay, let’s just put them on the market.” So believe it or not, these drugs were very safe, and a lot of these drugs were actually used during pregnancy. And then of course they realized that probably wasn’t a good idea, but there were actually no recorded adverse effects from that.

I do believe that these medications are only indicated for short-term weight loss as far as the FDA is concerned. It doesn’t mean that they can’t be used longer under a doctor’s jurisdiction or discretion, but many times they really aren’t. And that’s because long-term studies are not been done, I think we’d have known by experience, these three drugs have been around for fifty years, we know they’re pretty safe. However, they are related, at least chemically, to amphetamines. So if you look at the drug as a pharmacologist or a scientist, on a piece of paper the chemical equation of this drug looks very similar, what has the basic skeleton of an amphetamine. However, there really isn’t that much of a cross-reaction between these drugs and amphetamine. We don’t really believe that weight loss drugs are highly addictive, they’re really not that strong. They’re tolerated well by most people. So people in the know realize that if used prudently these drugs can be very helpful. They’re really not that different, any of the three drugs that I mentioned. I think probably phentermine is the most popular. I think most weight loss physicians feel that that is the best drug. It’s tolerated well by most patients, it works well, it lasts a while, it can be increased, you can increase the drugs in dosage and also frequency, so that’s probably number one. Number two is probably Phendimetrazine, which of course is very similar to. All these drugs are like first cousins. Diethylpropion, also known as Tenuate, is another drug in the appetites suppressant category. This is a drug that is chemically very similar to amphetamines. It is probably the weakest of the three drugs that we talked about. Many times it’s used by itself as a weak appetite suppressant, but Diethylpropion, can also be used as an add-on agent to phentermine, perhaps in the evening after phentermine wears off, the patient could take diethyl and use that for their evening hunger if necessary. If the person really is having trouble with their weight and these drugs alone are not good enough to control their appetite, there are other drugs that the physician can use in addition to these, as what we call “add-on agents.” Some of these drugs are used normally for conditions like seizures. There’s a drug called propylamine, which used to be known as PropiMax®. That drug was found, sort of like serendipitously, to have some weight loss effects. So that can be used on top of phentermine, so those two things can be used together. There’s also a drug called 5HT which is related to serotonin. The drugs that we use to treat depression are serotonin and dopamine, but this drug has the opposite effect. So that drug can be used and that can help with weight loss, but it usually has to be used with a preparation called carbidopa to maintain the presence in the bloodstream longer, otherwise, the body will break it down too quickly. So there are many different combinations that people can use.

That’s what I was going to say, that sounds like as a physician you are in a position to really help your patients by determining which combinations of drugs would be helpful.

And I think only a weight loss physician who really has a lot of experience in this area can really play with these different combinations. You know, I think your regular doctor that doesn’t have experience with this is probably not going to feel comfortable, and may not even know about the use of these different combinations, just as I said they are off-label. But another drug that can be very helpful, especially if the patient also has metabolic syndrome, which is a situation where people have high blood sugar, insulin resistance, and Trileptal obesity meaning a (big?) stomach and high triglycerides, that’s a very common thing among people that are overweight, is to have this metabolic syndrome that’s also associated with polycystic ovary disease. Many times there’s a drug name that (forman?) can be used, and that is basically in the diabetes category of drugs and that can help control blood sugar in people that have that problem, and it also can cause some weight loss. It also can cause perhaps ten pounds of weight loss in the first six months. Now that might tend to level off a bit, but it certainly is effective if the person has to take that drug anyway.

As far as the FDA is concerned, these appetite suppressant medications are not intended for long term use, so it really is up to the physician they’re supposedly only used for three months. However, I think that the FDA a lot of times is kind of behind in the thinking of bariatrics. I think a lot of these suggestions that were made by the FDA or laws I should say, or concerns were really developed many years ago before we really had the experience that we have now working with these drugs. It’s true that some people who really have trouble over the long haul controlling their appetite, might need to take some of these drugs for a long period of time; even patients who’ve undergone weight surgery, bariatric surgery, gastric bypass, or gastric band or any of the procedures that you’ve heard about. Some of these patients postoperatively need to be on appetite suppressants, otherwise, they’re going to undo the weight loss that they’ve achieved with surgery. Obesity is a chronic disease and it has to be treated that way.

The medical weight loss program at the Manhattan Medical Weight Loss Physician usually has our patients moving in the right direction within three months. Many times, patients have lost a considerable amount of weeks in our six or twelve-week programs, and then we re-evaluate them.

Not all of my patients are given weight loss medications, a lot of people don’t need them. The dietary plans that we advise people are quite high in protein. And the quality of protein in the food that we give them is excellent, and that is very important in controlling appetite. For many of our patients don’t even feel that they’re that hungry, and they don’t need to take weight loss medications. And of course, if you don’t need to take a medication, then certainly don’t take it. And yes, I think within three months, my average patient has a much better hold on their weight, but for someone who’s really morbidly obese and might have let’s say two hundred pounds to lose, you know you’re going to have to go a lot longer than three months to get close to your goal. So for a lot of those individuals, they may need to be on longer-term appetite suppression.

If you are interested in speaking to the doctor about varying medical weight loss programs at the NYC Medical Weight Loss Clinic – including diets, best practices, prescription weight loss, or techniques (including Thermage or Liposonix) – please contact the Doctor’s NYC medical weight loss center today to schedule your FREE consultation or simply request a consultation online using the eForm on the right.

Manhattan Medical Weight Loss
20 E 46th St., #1201
New York, NY 10017
Phone: (212) 490-7700