Sibutramine is a drug intended for the treatment of obesity. It acts at the level of the central nervous system with a mechanism of action similar to that of some antidepressant drugs, inhibiting the synaptic reuptake of noradrenaline, serotonin and to a lesser extent dopamine. These substances are excitatory neurotransmitters, or biochemical messengers responsible for the transmission of excitatory nerve signals.
More than improving the mood, sibutramine acts as an anoresistant drug, facilitating the appearance of the natural postprandial sense of satiety. The reduction of appetite has a positive effect on weight control, together with the thermogenic effect induced by the mediated sympathetic hyperactivation. from norepinephrine (increase in basal metabolism). At the same time, this latter aspect is however responsible for the side effects associated with therapy with sibutramine. Noradrenaline, in fact, in addition to increasing the consumption of oxygen at rest, raises blood pressure and heart rate; the onset of insomnia is also possible. , dry mouth, serotonin syndrome and headache. On average there is a rise in blood pressure of 2-4 mmHg for both the maximum and the minimum, while the heart rate accelerates on average by 4 or 6 beats per minute. This explains why sibutramine is contraindicated for all patients suffering from hypertension that is difficult to control and in the presence of a history of coronary artery disease, congestive heart failure, tachycardia, occlusive peripheral arterial disease, arrhythmia or cerebrovascular diseases (stroke or TIA). hyperthyroidism, glaucoma, renal or hepatic insufficiency, benign prostatic hypertrophy and urinary retention.
Several drug interactions are also reported, especially with antidepressant and anti-migraine drugs, which must be carefully evaluated by the doctor before prescribing the drug.
Six-month studies at sibutramine dosages ranging from 1 to 30 mg / day have demonstrated a positive, dose-dependent effect on weight loss. Compared to placebo, effective in this sense only in 0.9% of cases, the group treated with sibutramine at doses of 30 mg / day recorded a weight loss equal to 7.7% compared to the initial one. Positive effects were also observed in the reduction of blood values of triglycerides, total cholesterol, VLDL, C-peptide and uric acid.
Currently, sibutramine therapy is based on an initial dosage of 10 mg / day, which can be increased by 5 mg if necessary. On January 24, 2010, sibutramine was again banned from the market, as the risks of taking it outweigh the possible benefits.
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