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Obesity is a chronic disease producing an increasingly heavy burden on citizens, health care systems, workforce productivity, cities, and society at large. It should therefore be considered as a top priority, with increased commitments for concerted, coordinated, and specific actions.

The primary and the effective way of get away from obesity is lifestyle interventions including dietery restrictions regular exercise , reduce level of stress. If there is any secondary caouse identified for the obesity or overweight the cause should be treated. In that way we can reduce the danhgerous risk of complications of obesity such as cardiovascular disease , stroke  sleep apnea type 2 diabetes different cancer and psychosocial illnesses. In addition medical and surgical options are used in management of obesity in different levels of the management process . This article we tried to discuss pharmacological options which can be used in obesity and overweight management.

Obese and overweight , people  mainly helps with  of high-quality diet, physical activity and behavioural change remains the foundation for improved health outcomes. Pharmacotherapy for weight management is just an  adjunct to lifestyle intervention, not  a replacement. There are several medications currently used in the practice with real beneficial outcome. These includes Phentermine , orlistat and Liraglutide. Other medications to consider are topiramate , naltrexone and  bupropion

Phentermine (Duramine)

Phentermine is a sympathomimetic agent that suppresses appetite

Phentermine is given as a single daily dose. Starting with 15 mg and grading up gradually to  reduces  the risk of predictable, generally mild side effects (sympathomimetic) such as  dry mouth, insomnia, agitation, constipation and tachycardia.

it should not be used in patients with a history of cardiovascular disease, anxiety disorders, hyperthyroidism, history of drug or alcohol abuse or dependence, concomitant treatment with monoamine oxidase inhibitors, pregnancy and breastfeeding.

It should be used with caution in patients with hypertension, history of cardiac arrhythmias, or seizures.. Careful monitoring of blood pressure should be performed while the patient is on phentermine.

there is minimal evidence that long-term phentermine monotherapy is associated with serious side effects. It is recommends careful evaluation before and at three months of use. Further use is considered if there no significant  cardiovascular risk , no serious psychiatric disease or history of substance abuse and No serious side effects experienced during the treatment.

Orlistat

Orilstat inhibits pancreatic and gastric lipases so that  reduces absorption of dietary fat. Taken in a dose of 120 mg three times a day with meals, approximately 30% of oral fat intake is excreted in the stool. Side effects are due to fat malabsorption they includes  steatorrhoea, flatulence with discharge, faecal incontinence, fat-soluble vitamin deficiencies and calcium oxalate kidney stones.

The side effects can be reduced by adhering to a low-fat diet and increasing dietary fibre.

Liraglutide

Liraglutide is a glucagon-like peptide-1 (GLP-1) agonist. It is used in controlling hyperglycaemia in type 2 diabetes without causing hypoglycaemia or weight gain. It also reduce weight and improve glycaemic control and reduce cardiovascular risk.

It can be given as a subcutaneous injection. The starting dose of liraglutide is 0.6 mg once daily. The dose should be increased to 3 mg in increments of 0.6 mg, with intervals of at least one week to improve gastrointestinal tolerability.

Common side effects of liraglutide are gastrointestinal in nature, including nausea, vomiting, diarrhoea, constipation and dyspepsia. Most gastrointestinal symptoms are mild to moderate, transient and diminish within days or weeks with continued treatment. Liraglutide-induced weight loss is associated with an increased incidence of symptomatic gallstones and, more rarely, pancreatitis. Liraglutide should not be used in those with severe renal insufficiency (including end-stage renal failure), hepatic insufficiency, pregnancy, past history of pancreatitis or major depression, or psychiatric disorder.

Topiramate is an anticonvulsant used to treat seizures and for migraine prophylaxis. Its side effect of weight loss is used as for a weight loosing medication.

naltrexone/bupropion combination and lorcaserin. The combination of an opioid antagonist (naltrexone) and a dopamine and noradrenaline re-uptake inhibitor (bupropion) has been used as an another pharmacological option. Lorcaserin, a selective 5-hydroxytryptamine (5-HT) 2C receptor agonist is also reduce the appetite.

Despite the efficacy of pharmacotherapy in producing weight loss, drugs used for weight loss are often discontinued. Reasons for cessation of therapy include costs, concerns regarding side effects and the perception that the medication is no longer necessary as a sufficient amount of weight is lost. On the contrary, if therapy is well tolerated and effective, it should be continued, similarly to the way antihypertensive and antidiabetic medications are continued even after blood pressure or glycaemic control is at target. This reflects the fact that obesity is a chronic disease that requires sustained treatment, with pharmacotherapy playing an important role in promoting long-term weight maintenance and limiting weight regain……SW……( referrence RACGP Guidelines )

 

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