blood pressure increase, arrhythmias,Prozac, norepinephrine, serotonin
Sibutramine (Meridia) Withdrawn Oct 2010
Meridia has been one of the most prescribed of recent weight loss drugs. We
have expressed concerns about Meridia's efficacy and safety over the past 10
years and have advised against its use. Favorable pre-marketing studies showed
modest weight loss benefits and the manufacturer claimed that sibutramine was a
safe and effective drug. More objective data suggested that its modest
benefits are not significant in light of potentially serious adverse effects.
Meridia was associated with death from cardiovascular causes. The drug was
withdrawn first in Italy and was under scrutiny in other countries. The know
effects of sibutramine include increases in blood pressure, heart rate and
arrhythmias. This drug is similar to Prozac and was originally developed as an
antidepressant. Its main action is to increase serotonin transmission in the
brain by inhibiting the reuptake of the neurotransmitter. Increased serotonin
activity in appetite regulating regions of the brain are associated with
decreased appetite. Sibutramine taken with other antidepressants increased
norepinephrine and serotonin levels. Its use was contraindicated in patients
with cardiovascular disease. James et al reported as study of 10,744 overweight
or obese subjects 55 years and older with preexisting cardiovascular conditions
who were given long-term sibutramine treatment have an increased risk for
nonfatal myocardial infarction and nonfatal stroke, but not cardiovascular death
or all-cause mortality.
In October, 2010 the US FDA announced that Abbott Laboratories withdrew
sibutramine (Meridia) from the market in light of clinical trial data pointing
to an increased risk for stroke and myocardial infarction. The Sibutramine
Cardiovascular Outcomes Trial (SCOUT), demonstrated a 16% increase in the risk
for serious cardiovascular events such as nonfatal heart attack, nonfatal
stroke, the need for resuscitation after the heart stopped, and death in a
cohort of patients given sibutramine compared with another given a placebo.
Consider an objective evaluation of the drug published In 2001.
Sibutramine: slight weight loss. Prescrire Int 2001 Oct;10(55):140-5 (ISSN:
(1) The reference treatment for achieving weight loss by obese patients is a
combination of dietary measures, exercise and behavioral interventions. There
is currently no drug treatment with demonstrated efficacy on the morbidity or
mortality associated with excess body weight.
(2) Sibutramine, a serotonin- and
noradrenaline-reuptake inhibitor structurally related to the amphetamines has
been granted marketing authorization in France for the treatment of obesity and
excess body weight in patients with associated risk factors.
(3) The clinical file on sibutramine contains no trial focusing on morbidity or mortality end
(4) According to comparative clinical trials, weight loss during a 6-12
month course of sibutramine is, on average, between 3 and 9 kg greater than that
on placebo. Patients regain weight after sibutramine cessation. (5) Sibutramine
has little or no benefit on blood sugar or lipid parameters. (6) The main known
adverse effect of sibutramine is increased blood pressure. Sibutramine also has
amphetamine-like side effects.
(7) In practice, sibutramine currently has no
place in the management of obesity.
See Eating and Weight Management
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