Posted by: Chris Maloney | November 3, 2011

Bubba Smith and Phentermine: Wt. Loss or Amphetamine?

Main complications of persistent high blood pr...

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The LA Times reports that Bubba Smith has passed.  His name alone should have made him memorable, but he made the crossover from athlete to actor as well.

They found toxic doses of phentermine in his system.  Was he really trying to lose weight that fast?  Or is it more likely he was using it to increase mood, energy and wakefulness?

Some of the studies on the drug show it doesn’t increase blood pressure at normal doses, but the major studies all show it does.  The drug is an upper, leading to metabolic increased burning while on it and recovery with weight regain when you come off it.  It is the definition of a yo-yo diet plan.  If you don’t have high blood pressure and you plan to stay on the drug the rest of your life, fine.  Otherwise, this should be reconsidered.  I remember when athletes started dropping from the herb Ephedra.  We banned it.  But this is a drug, so watch for spin control and nothing to happen.

Do they know the drug is safe at regular doses?  Currently no study on the drug has monitored either cardiovascular events or mortality.  So no, we have no data.

Obesity (Silver Spring). 2011 Apr 28. [Epub ahead of print]


Blood Pressure and Heart Rate Effects, Weight Loss and Maintenance
During Long-Term Phentermine Pharmacotherapy for Obesity.


Hendricks EJ, Greenway FL, Westman EC, Gupta AK.





1] The Center for Weight Management, Roseville, California, USA [2] The
Center for Weight Management, Sacramento, California, USA.





There is a perception that phentermine pharmacotherapy for obesity
increases blood pressure and heart rate (HR), exposing treated patients to
increased cardiovascular risk. We collected data from phentermine-treated (PT)
and phentermine-untreated (P0) patients at a private weight management
practice, to examine blood pressure, HR, and weight changes. Records of 300
sequential returning patients were selected who had been treated with a low-carbohydrate
ketogenic diet if their records included complete weight, blood pressure, and
HR data from seven office examinations during the first 12 weeks of therapy.
The mean time in therapy, time range, and mode was 92 (97.0), 12-624, and 52
weeks. 14% were normotensive, 52% were prehypertensive, and 34% were
hypertensive at their first visit or had a previous diagnosis of hypertension.
PT subjects systolic blood pressure/diastolic blood pressure (SBP/DBP) declined
from baseline at all data points (SBP/DBP -6.9/-5.0 mm Hg at 26, and -7.3/-5.4
at 52 weeks). P0 subjects’ declines of SBP/DBP at both 26 and 52 weeks were
-8.9/-6.3 but the difference from the treated cohort was not significant. HR
changes in treated/untreated subjects at weeks 26 (-0.9/-3.5) and 52
(+1.2/-3.6) were not significant. Weight loss was significantly greater in the
PT cohort for week 1 through 104 (P = 0.0144). These data suggest phentermine treatment for obesity does not result in
increased SBP, DBP, or HR, and that weight loss assisted with phentermine
treatment is associated with favorable shifts in categorical blood pressure and
retardation of progression to hypertension in obese patients.



PMID: 21527891






Cochrane Database Syst Rev. 2003;(4):CD004094.


Long-term pharmacotherapy for obesity and overweight.


Padwal R, Li SK, Lau DC.





Division of Clinical Pharmacology, Sunnybrook and Women’s College
Health Sciences Center, Room E2-42, 2075 Bayview Avenue, Toronto, Ontario,
Canada, M4N 3M5.



Update in

Cochrane Database Syst Rev. 2004;(3):CD004094.







Worldwide prevalence rates of obesity and overweight are rising and
safe and effective treatment strategies are urgently needed. A number of
anti-obesity agents have been studied in short-term clinical trials, but
long-term efficacy and safety need to be established.




To assess/compare the effects and safety of approved anti-obesity
medications in clinical trials of at least one-year duration.




MEDLINE, EMBASE, the Cochrane Controlled Trials Register, the Current
Science Meta-register of Controlled Trials, and reference lists of original
studies and reviews were searched. Date of last search was December 2002. Drug
manufacturers and two obesity experts were contacted in to detect unpublished
trials. No language restrictions were imposed.




Double-blind, randomised controlled weight loss and weight maintenance
trials of approved anti-obesity agents that 1) enrolled adult overweight or
obese patients, 2) included a placebo control group or compared two or more
anti-obesity drugs 3) used an intention-to-treat analysis, and 4) had a minimum
follow-up period of one year. Abstracts and pseudo-randomised trials were not




Two reviewers independently assessed all potentially relevant citations
for inclusion and methodological quality. The primary outcome measure was
weight loss.




Of the eight anti-obesity agents investigated, only orlistat and
sibutramine trials met inclusion criteria. Eleven orlistat weight loss studies
(four of which reported a second year weight maintenance phase) and five
sibutramine studies (three weight loss and two weight maintenance trials) were
included. Attrition rates averaged 33% during the weight loss phase of orlistat
trials and 43% in sibutramine studies. All patients received lifestyle
modification as a co-intervention. Compared to placebo, orlistat-treated
patients lost 2.7 kg (95% CI: 2.3 kg to 3.1 kg) or 2.9% (95% CI: 2.3 % to 3.4%)
more weight and patients on sibutramine experienced 4.3 kg (95% CI: 3.6 kg to
4.9 kg) or 4.6% (95% CI: 3.8% to 5.4%) greater weight loss. The number of
patients achieving ten percent or greater weight loss was 12% (95% CI: 8% to
16%) higher with orlistat and 15% (95% CI: 4% to 27%) higher with sibutramine
therapy. Weight loss maintenance results were similar. Orlistat caused
gastrointestinal side effects and sibutramine
was associated with small increases in blood pressure and pulse rate.




Studies evaluating the long-term efficacy of anti-obesity agents are
limited to orlistat and sibutramine. Both drugs appear modestly effective in
promoting weight loss; however, interpretation is limited by high attrition
rates. Longer and more methodologically rigorous studies of anti-obesity drugs
that are powered to examine endpoints such as mortality and cardiovascular
morbidity are required to fully evaluate any potential benefit of such agents.



PMID: 14584004






Cochrane Database Syst Rev. 2009 Jul 8;(3):CD007654.


Long-term effects of weight-reducing drugs in hypertensive patients.


Siebenhofer A, Horvath K, Jeitler K, Berghold A, Stich AK, Matyas E, Pignitter
N, Siering U.





Department of Internal Medicine and Institute for Medical Informatics,
Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 15,
Graz, Austria, 8036.







All major guidelines for antihypertensive therapy recommend weight
loss; anti-obesity drugs might be a helpful option.







To assess the long-term effects of pharmacologically induced reduction
in body weight with orlistat, sibutramine or rimonabant on:- all cause
mortality – cardiovascular morbidity – adverse eventsSecondary objectives: –
changes in systolic and/or diastolic blood pressure – body weight reduction




Studies were obtained from computerised searches of Ovid MEDLINE,
EMBASE, CENTRAL and from hand searches in reference lists and systematic




Randomized controlled trials in adult hypertensive patients with a
study duration of at least 24 weeks comparing pharmacologic interventions
(orlistat, sibutramine, rimonabant) for weight loss with placebo.




Two authors independently assessed risk of bias and extracted data.
Studies were pooled using fixed-effect meta-analysis in the absence of significant
heterogeneity between studies (p>0.1). Otherwise, we used the random effects
method and investigated the cause of heterogeneity.




Eight studies comparing orlistat or sibutramine to placebo fulfilled
our inclusion criteria. No relevant studies investigating rimonabant for weight
loss were identified. No study included
mortality and cardiovascular morbidity as a pre-defined outcome
. Incidence
of gastrointestinal side effects was consistently higher in orlistat treated
vs. placebo treated patients. Most frequent side effects with sibutramine were
dry mouth, constipation and headache. Patients assigned to weight loss diets,
orlistat or sibutramine reduced their body weight more effectively than
patients in the usual care/placebo groups. Blood pressure reduction in patients
treated with orlistat was for systolic blood pressure (SBP): weighted mean
difference (WMD): -2.5 mm Hg; 95% CI, -4.0 to -0.9 mm Hg and for diastolic
blood pressure (DBP): WMD -1.9 mm Hg; 95% CI, -3.0 to -0.9 mm Hg. Meta-analysis
showed DBP increase under therapy with sibutramine: WMD +3.2 mm Hg; 95%CI +1.4
to +4.9 mm Hg.




In patients with elevated blood pressure, orlistat and sibutramine
reduced body weight to a similar degree. In the same trials, orlistat reduced
blood pressure and sibutramine increased blood pressure. No trials
investigating rimonabant in people with elevated blood pressure could be
included. Long-term trials assessing the effect of orlistat, sibutramine and
rimonabant on mortality and morbidity are needed.


PMID: 19588440



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