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    Diet drugs: Phentermine prescribed twice as often as Xenical and three times as often as Meridia


    Posted by .(JavaScript must be enabled to view this email address)
    Thursday, September 09, 2004 10:01 am Email this article
    In 2002, phentermine was used to treat obesity twice as often as Xenical (orlistat) and three times as often as Meridia (sibutramine). In 1997, 2.5 million Americans were taking diet drugs

    Diet drug use peaked during the second quarter of 1997.

    In 1997, 4 times as many taking diet drugs as two years prior

    At that time, 2.5 million Americans were taking antiobesity medications, a 4-fold increase over the prior two years.

    Here is a nice graph from the paper about diet drug use in the U.S from 1991 to 2002.

    U.S. Diet Drug use from 1991 to 2002

    The figure represents the total number of reported obese patients, total number of prescriptions for antiobesity medications, and number of patients receiving medication treatment for obesity in the United States from 1991 to 2002. The data for 2002 was estimated from the first three months. The data was provided by IMS HEALTH.

    Phentermine prescriptions: 1.2 million per year; Xenical, 0.6 million; Meridia, 0.4 million

    The number of prescription per year for phentermine increased from 1.0 million in 1991 to 1.5 million in 1994, then to 2.3 million in 1995, and then to 5.0 million in 1996. This increase was mostly the result of the popularity of Fen-Phen (the combination of fenfluramine and phentermine).

    After 1997, phentermine use has continued to decline gradually, although in 2002 it still remained the most commonly prescribed diet drug.

    Comment: My guess is that phentermine use has declined, because some doctors who do NOT specialize in obesity are using Meridia (sibutramine) and Xenical (orlistat) instead of phentermine. This might be partially due to an fear of phentermine, or perhaps more likely, because of the marketing of Meridia (sibutramine) and Xenical (orlistat). Because phentermine is an old drug and available as a generic, it is not marketed the way that Meridia (sibutramine) and Xenical (orlistat) are.

    In 2002, roughly 1.2 million people were treated with phentermine compared to 0.6 million for Xenical (orlistat) and 0.4 million for Meridia (sibutramine).

    Comment: For people wondering about how phentermine compares with Meridia (sibutramine) and Xenical (orlistat), as far as I remember, every doctor I have spoken to who specializes in obesity say that they prefer phentermine over either Meridia (sibutramine) and Xenical (orlistat). My understanding is that they simply use these other drugs when a person cannot tolerate phentermine or cannot use it for some reason, or sometimes using Xenical with phentermine, or when a patient specifically asks for Meridia (sibutramine) and Xenical (orlistat).

    Here is a nice graph from the paper about prescriptions per year for each diet drug.

    The figure represents the number of prescriptions for each diet drug in the United States from 1991 to 2002. The data for 2002 was estimated from the first three months. The data was provided by IMS HEALTH.

    U.S. Individual Diet Drug use from 1991 to 2002

    Fenfluramine prescriptions: 0.1 million in 1993; 0.8 million in 1995; 3.8 million in 1996

    The number of prescription per year for fenfluramine (Pondamin) increased from 0.1 million in 1991 to 0.8 million in 1995, then to 3.8 million in 1996. Fenfluramine was removed from the market in 1997 because of heart valve problems.

    Dexfenfluramine prescriptions: 0.1 million in 1993; 0.8 million in 1995; 3.8 million in 1996

    A total of 1.1 million prescriptions were written for dexfenfluramine (Redux) in 1996, the year it was released. Dexfenfluramine was also removed from the market in 1997 because of heart valve problems.

    Other stimulant diet pill prescriptions: 0.3 million in 1991; 0.15 million in 2002

    “The use of other amphetamine and sympathomimetic drugs has decreased gradually from 0.3 million… in 1991 to… 0.15 million in 2002,” the authors note. “In part, this trend reflected diminished use of phenylpropanolamine [PPA] in the mid-1990s, well before its market withdrawal in 2000.”

    Herbal therapies taken by less than 1 percent of obese people

    “Although several other medications also were listed as therapies for obesity, such as herbal therapies and diuretics, none of these were reported more frequently than in 1% of obese patients,” the paper notes. However, “The use of over-the-counter and herbal therapies may not have been reliably reported,” the authors also acknowledge.

    50% of patients diagnosed as obese prescribed diet drugs in 1991, 85% in 1996, 64% in 2002

    Diet drugs were prescribed to 50% of patients diagnosed as obese in 1991, 85% in 1996, and 64% in 2002.

    Use of diet drug combinations increased by 1996, but fell by 2002

    The number of diet drugs used per patient also increased from 1.1 in 1991 to 1.6 in 1996 before falling to 1.1 in 2002.

    Comment: At least one prominent researcher has written that in the future it seems likely that the use of drug combinations will be used more often not only to treat obesity, but also to lower blood pressure and improve cholesterol levels. The idea behind using drug combinations is to increase the effectiveness while reducing the risk of side effects of any one drug.

    Articles about Topamax and Zonegran

    For people interested in other drugs causing weight loss, see the articles about Topamax (topiramate) and Zonegran (zonisamide).

    Sample: 13,452 physician visits from 1991-2002

    The study was based on a nationally representative sample of US office-based 13,452 physician visits from 1991 to 2002 for which the doctor diagnosed the patient as being obese.

    REFERENCE

    Stafford R, Radley D. National trends in antiobesity medication use. Arch Intern Med. 2003 May 12, 163(9):1046-50.

    AUTHOR’S CONTACT INFORMATION

    R. Stafford
    Stanford Center for Research in Disease Prevention
    1000 Welch Road
    Palo Alto, CA 94304, USA
    .(JavaScript must be enabled to view this email address)

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