Diet Pills: Composition, Therapeutic use, Treatment. Diet Pills effects. Reactions with other drugs.

Last modified: Sunday, 31. May 2009 - 4:22 am

Official names: Benzphetamine (Didrex), dexfenlu-ramine (Redux), diethylpropion (Tenuate, Tenuate dospan, Tepanil), fenfluramine (Pondimin), mazindol (Sanorex, Mazanor), methamphetamine (Desoxyn), orlistat (Xenical), phendimetrazine (Bontril, Plegine, Prelu-2, X-Trozine), phenter-mine (Adipex-P, Fastin, lonamin, Oby-trim), sibutramine (Meridia)
Street names: Methamphetamine: Speed, crank
Drug classifications: Schedule II, III, and IV, stimulant

 

Key terms

ANORECTICS: Diet pills developed to replace amphetamines.
ESOPHAGUS: The tube in the throat that carries food to the stomach.
LI PI DS: A group of organic compounds consisting of fats and other substances.
METABOLISM: The body’s ability to break down and process substances taken into the body.
SCHIZOPHRENIA: A medical condition that falls under the category of psychotic disorders. People with schizophrenia suffer from a variety of symptoms, including confusion, disordered thinking, paranoia, hallucinations, emotional numbness, and speech problems.
SYMPATHOMIMETIC: Amedication similar to amphetamine, but is less powerful and has less potential for addiction than amphetamine.

 

Overview

The use of diet pills to lose weight is a twentieth-century phenomenon that carried over into the twenty-first century. During earlier centuries, society regarded plumpness as a sign of good health. Up until the late nineteenth century, a full figure indicated financial status, because a plump person could afford to eat.
An 1880s American drawing portrayed a woman asking her doctor for advice about a “fattening cure” to help her gain weight. A sign on the doctor’s wall showed a list of “Flesh Forming Ingredients” that include cocoa extract and French chocolates.
The first diet pill
Attitudes about weight had changed somewhat by 1893 when the first diet pill was marketed. The pill was a thyroid extract sold under names like “Frank J. Kellogg’s Safe Fat Reducer.” People lost weight. However, there were dangerous side effects for people who did not have a hypothyroid condition. Hypothyroidism is a glandular condition characterized by an impaired rate of metabolism.
People who did not have the glandular condition and took the extract could experience chest pains, an increased heart rate, and higher blood pressure. Some died suddenly.
People used the thyroid hormone as a weight loss remedy until the 1950s. At the start of the twenty-first century, only hypothyroid patients received thyroid hormones as a weight-loss treatment.
Diet remedies of the 1920s
The 1920s were a time of change. During the decade known as the “Roaring ’20s,” women smoked cigarettes in public and shortened their hemlines to reveal their legs. While both activities were considered shocking, they reflected a new freedom for women.
Attitudes also changed about weight. People, especially women, regarded a thin body as the ideal figure. That attitude continued into the twenty-first century. Excess weight was seen as a sign of character flaws such as a lack of self-control, laziness, or poor self-image.
During the 1920s, people trying to lose weight took laxatives — medicines that relieve constipation by loosening the bowels. Through the decades, people continued to use laxatives to lose weight.
Also in the 1920s, weight loss products included La-Mar Reducing Soap. This product promised to “wash away fat and years of age,” according to an advertisement from the London, England soap manufacturer.
Soap and other weight-loss gimmicks were put aside in 1933 when dinitrophenol went on the marketed as a weight loss drug. People began taking this drug after learning about the weight lost by textile factory workers exposed to dinitrophenol during the 1900s.
Thousands take dinitrophenol
Dinitrophenol was used in explosives during World War I. It was used as an insecticide and an herbicide. It was also a popular weight loss remedy; 100,000 people took dinitrophenol in 1936.
This diet pill increased a person’s metabolic rate, but it had dangerous side effects. At least 12 women who took it lost their eyesight. Other people lost their sense of taste; dinitrophenol caused skin rashes. People died from hyperpyrexia, an abnormally high fever brought on by increased metabolism.
Those dangerous and sometimes fatal side effects led the United States Congress to enact the Food, Drug, and Cosmetics Act in 1938. The act gave the Food and Drug Administration (FDA) powers to regulate substances marketed as drugs.
Some people still purchased dinitrophenol through mail-order businesses during the 1940s. Use of this drug declined until the late twentieth century, when bodybuilders took dinitrophenol as a weight loss remedy. The
FDA and law enforcement officials were again investigating the sales and misuse of the drug linked to the death of a New York man in September 2001.
In earlier decades, use of dinitrophenol dropped as dieters discovered amphetamine, a medication developed in 1887. Amphetamine stimulates the central nervous system, which can reduce a person’s appetite. Caffeine, which is found in beverages like coffee, is a weak stimulant. During the twentieth century, dieters would drink coffee and take amphetamines to lose weight.
Medical uses of amphetamines
During the 1930s, European doctors prescribed amphetamines to treat respiratory conditions such as colds, hay fever, and asthma. The medications were also used to treat narcolepsy, a condition in which a patient experiences uncontrollable attacks of sleep. In addition, amphetamines were used to calm hyperactive children.
While the drugs soothed children with the condition now known as attention deficit hyperactivity disorder (ADHD), most people experienced a completely different reaction to amphetamines. The drugs gave them more energy and helped them to stay awake.
Those effects led to another use of amphetamines during World War II. Soldiers from America, Britain, Japan, and Germany took amphetamines to combat the weariness of battle fatigue.
The immediate effects of using amphetamines are additional energy, an exhilarated feeling of happiness known as euphoria, and increases in activity and concentration levels. The drugs also reduce the sensation of being hungry.
Dieters discover amphetamines
In 1937, the amphetamine dextroamphetamine was sold as a diet pill under the trade name Dexedrine. This medication was twice as potent as other amphetamines. It was also regarded as having the least amount of side effects. However, amphetamines were highly addictive.
People called amphetamines “uppers” because the drugs gave them energy. Sometimes that side effect meant that people could not sleep at night. As a result, they took sleeping pills. Referred to as “downers,” these drugs were extremely addictive barbiturates that some users called liquid alcohol.
Taking barbiturates helped people sleep, but the drugs interfered with the dream patterns that come with restful sleep. People woke up feeling tired and took an amphetamine so they would be “up” again.
The FDA in 1938 realized that amphetamines and barbiturates had a strong potential for “misuse and abuse.” The federal agency used its new regulatory powers and declared that prescriptions were required for both drugs. Physicians or dentists could write those prescriptions.
Widespread drug abuse
During the 1940s and 1950s, amphetamines and barbiturates were the most widely abused drugs in the United States, according to an FDA report.
A prescription was needed for amphetamines, but people who were dependent on these drugs found ways to get them legally. They went to doctors who would continue to write refill prescriptions for amphetamine diet pills. Another option was to go to more than one doctor. People also went to diet clinics or found pharmacists who did not ask for a prescription.
For people who acted in movies, studio doctors supplied medications that helped them lose weight and work 18-hour days. Although Hollywood and celebrities had a different lifestyle than most Americans, their experiences mirrored the belief of the time that amphetamines and barbiturates were an accepted part of American life.
When actress Sheree North filmed the 1956 movie How to Be Very, Very Popular, she received methamphetamine shots, bottles of Benzedrine (another amphetamine) for daytime use and the barbiturate Nembutal to sleep at night. The actress described that situation in the book Marilyn: The Last Take. In the 1993 book written by Peter Harry Brown and Patte Barham about the late actress Marilyn Monroe, North said that people did not know the drugs were harmful. She became addicted to the drugs, as did Monroe.
Amphetamine and barbiturate abuse was so widespread that the FDA worked from the 1940s through the 1960s on that problem. The FDA prosecuted doctors and pharmacies, while other federal agencies combatted illegal sales of prescription drugs.
The government also realized that the legal sale of amphetamines was a problem. During the 1960s, youths curious about drugs could find amphetamines in their parents’ medicine cabinets.
Access to amphetamines restricted
In 1970, pharmaceutical companies in the United States produced 12 million amphetamine tablets. That same year, the Senate and House of Representatives ratified the Comprehensive Drug Abuse Prevention and Control Act. The law restricted the access to highly addictive drugs like amphetamines.
During the 1970s, amphetamines accounted for 8% of prescriptions in the United States. In addition to dieters, other amphetamine users included long-distance truck drivers and college students. Both groups took the pills to stay awake.
With the nation aware of the dangers of amphetamines, pharmaceutical companies worked to produce diet pills with less potential for misuse or abuse.
Alternates to amphetamines
Pharmaceutical companies developed diet pills with amphetamine congeners, chemicals that were similar to amphetamines. Although not as potent as amphetamines, these pills had more of an appetite-reducing effect than caffeine.
The diet pills developed to replace amphetamines became known as anorectics or appetite suppressants and are central nervous system stimulants. The FDA approved phentermine in 1959, fenfluramine in 1973, and dexfenfluramine in 1996.
The FDA approved the appetite suppressants for the short-term treatment of obesity. The FDA does not place restrictions on what conditions a physician prescribes the pills for, the dosage, or the amount of time that the patient takes the pills.
Prescribing medications for times or conditions not approved by the FDA is called “off-label” use. Examples of off-label use include prescribing a short-term drug for a longer period or time and prescribing a combination of two weight loss medications.
Off-label use
Off-label use during the 1990s became an issue after doctors in the United States and other countries began prescribing fenfluramine (Pondimin) or dexfenfluramine (Redux) in combination with phentermine. The combinations known informally as “fen-phen” (sometimes also written as “phen-fen”) or “fen-dex” had not been approved by the FDA, a process that involves research and hearings.
Media reports about the diet pill combinations focused on the promise of weight loss. The public embraced the message, ignoring the fact that these pills were anti-obesity drugs to be used for only several weeks.
Millions of prescriptions
People clamored for the pill combination that helped them take off the pounds. More than 18 million prescriptions were written for fen-phen in 1996, according to Time magazine.
The diet pill combination posed a health risk. Side effects from long-term use included primary pulmonary hypertension (PPH). This is a rare condition that affects blood vessels in the lungs. The disease is potentially fatal, with death occurring within four years in 45% of its victims.
Most PPH deaths occurred to people taking fenfluramine or dexfenfluramine separately or in combination, according to a 2001 report from the National Institutes of Health (NIH). In 1996, there was also concern that long-term use of those drugs could damage brain cells.
The diet pill combination posed another risk. The Mayo Clinic announced that 24 patients who used the combination were diagnosed with valvular heart disease. In these cases, the condition caused leakiness (regurgitation) in the valves, according to an FDA report.
The federal agency issued a July 8, 1997 health advisory that stated that the FDA had received 100 reports of heart valve disease. The condition was diagnosed in people who took fen-phen as well as those who used only dexfenluramine or fenfluramine. The FDA noted that the combination treatment had not received FDA approval. In addition, FDA approval was based on short-term use for obesity treatment.
The FDA had also received requests to take the drugs off the market. The requests based on health concerns came from organizations including the National Association for the Advancement of Fat Acceptance, and Public Citizen, the advocacy group founded by consumer advocate Ralph Nader.
Available anorectics
In 1997, the manufacturers withdrew fenfluramine and dexfenfluramine from the market. Phentermine is still sold because no cases of heart valve disease were reported when that drug was taken alone, according to the FDA report.
Also on the market were anorectic diet pills including benzphetamine, diethylpropion, mazindol, and phendimetrazine. Another anorectic, methamphetamine, was sold under the trade name Desoxyn. It was also prescribed for the treatment of ADHD.
Methamphetamine is highly addictive and rarely prescribed for the short-term treatment of obesity. It is abused by addicts who may inject the drug.
Long-term diet pills
In 1997, the FDA approved sibutramine, a medication sold under the brand name Meridia. Sibutramine is an appetite suppressant prescribed for long-term treatment of severely obese patients. However, safety and effectiveness had not been determined when the sibutramine was taken for more than one year.
Another type of diet pill received FDA approval in 1999. Orlistat, sold under the name of Xenical, was a lipase inhibitor. It affects the body’s lipase enzyme and blocks about 30% of fat absorbed by the body.
Diet pill concerns in the twenty-first century
In March of 2002, Public Citizen filed a petition calling for the FDA to ban Meridia. Public Citizen quoted from FDA documents that showed that use of sibutramine was allegedly associated with 29 deaths and 400 adverse medical reactions. Those incidents occurred throughout the world, and Italy had banned the drug. The issue was also being studied by the United Kingdom, which banned phentermine in 2000. The ban was prompted by concern that it could cause heart disease.
A spokesman for Abbott Labs, which manufactures Meridia, said that Abbott had not seen evidence of a connection between use of sibutramine and the deaths and medical reactions. As of April of 2002, the FDA had not taken action to ban the drug.
Twenty-first century diet remedies
By the start of the twenty-first century, research was underway on at least 20 different diet pills. While some twentieth-century diet pills like Dexedrine were no longer prescribed for weight loss, people attempting to lose weight used methods tried by other generations. People with eating disorders took laxatives. Some dieters drank coffee to suppress their hunger cravings, or they tried nonprescription remedies. Caffeine is an ingredient in many over-the-counter diet remedies.
Some dieters tried herbal remedies. These are not regulated by the FDA, and patients should check with a medical professional before taking herbal medications.

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