Sibutramine
Brand names
Usage
To aid in the medical management of obesity in conjunction
with a carefully supervised
diet and exercise program. The
medicament is only recommended
for overweight people with a
body mass index (BMI) of 30
or greater, or a BMI of 27 or
greater in people with other
risk factors, such as diabetes
or high blood pressure.
How it works
Sibutramine affects the
appetite control center in the
brain by inhibiting the reuptake of neurotransmitters like
serotonin. The resulting
increase in their availability
suppresses appetite.
Side effects
- Serious
- If you experience symptoms, such as shortness of breath
or chest pain, that were not present before taking the
medication, seek medical help.
- Common
- Dry mouth,
constipation,
insomnia.
- Less common
- Headache, increased
sweating, increased
blood pressure
and heart rate.
Possible interactions
- Other medicaments:
Sibutramine taken concurrently with:
- antimigraine agents (such as sumatriptan or Imitrex) and
dihydroergotamine may rarely result in a serotonin syndrome
- central nervous system active medicines (benzodiazepines,
opioids [fentanyl, etc.], phenothiazines and others) may
have additive effects-caution is advised.
- dextromethorphan (various brands of cough medicine) may increase risk of
serotonin syndrome.
- lithium (Lithobid, others) increases risk of serotonin syndrome.
- meperidine (Demerol, others) increases risk of serotonin syndrome.
- monoamine oxidase (MAO) inhibitors may result in
serious, even fatal reactions. Fourteen days should pass between stopping an
MAO inhibitor and starting sibutramine.
- pentazocine (Talwin, others) increases risk of serotonin syndrome.
- selective serotonin reuptake inhibitors increases
risk of serotonin syndrome
- tricyclic antidepressants (some, such as desipramine [Norpramin] and
amitriptyline [Elavil]) increase serotonin syndrome risk.
- tryptophan (various) increases risk of serotonin syndrome.
Sibutramine taken concurrently with the following may result in increased sibutramine levels:
- erythromycins.
- itraconazole (Sporanox).
- ketoconazole (Nizoral).
- mibefradil (Posicor).
- nelfinavir (Viracept) and perhaps other protease inhibitors may increase blood levels.
- any medicine that interferes with cytochrome CYP3A4 or is removed from
the body by those enzymes will potentially increase sibutramine blood
levels.
The following medicaments may decrease the effects of sibutramine:
- rifabutin (Mycobutin).
- rifampin (Rifadin, Rimactane).
- Foods:
- Follow prescribed portion control and menu choices. Tryptophan (found
in some health food stores) increases risk of serotonin syndrome.
- Herbal medicines or minerals:
- Combining this medicine with St. John's
wort is not advised because of possible serotonin syndrome. Since part of the
way ginseng works may be as an MAO inhibitor, do not combine ginseng
with sibutramine. Ma huang, kola, and
yohimbe are also best
avoided while taking this medicine.
Dietary counseling and physician- or dietitian-directed
menus and portion control are suggested.
- Alcohol:
- The manufacturer does not recommend use of excessive
alcohol and sibutramine.
- Occurrence of unrelated illness:
- Since weight loss may modify the need for
medicines used to control blood pressure and lipids, the medicines used in these
conditions may need to be adjusted.
- Discontinuation:
- Ask your doctor for help if you are considering stopping this
medicine.
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