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Al Jumaili W, Muzwagi A, Shah K, Trivedi C, Durga P, Mansuri Z, Jain S, Al Jumaili Y. Pharmacological Interventions of Atypical Antipsychotics Induced Weight Gain in the Pediatric Population: A Systemic Review of Current Evidence. Child Psychiatry Hum Dev 2024; 55:479-487. [PMID: 36066654 DOI: 10.1007/s10578-022-01424-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 12/18/2022]
Abstract
To systematically review studies evaluating pharmacological treatment intervention of the atypical antipsychotic induced weight gain in the pediatric population and summarize the current evidence of the pharmacological treatment. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we searched the various databases Medline, PubMed, PubMed central (PMC), CINAHL, and clinicaltrial.gov. until Jan 30th, 2022 for relevant clinical studies. Medical subject heading (MeSH) terms or keywords were used, "Body Weight," "Weight Gain," "Weight Loss," "Body Weight Maintenance," "Pediatric Obesity" in "Pediatrics," "Adolescent," "Child" in context of "Antipsychotic Agents" and "Drug Therapy," "Therapeutics," "Treatment Outcome," "Early Medical Intervention." We used the PICO algorithm for our search (Population, Intervention, Comparison, Outcomes, and Study Design) framework. The initial search included 746 articles, nine studies were ultimately selected in the final qualitative review. We included relevant clinical reviews, case series, and randomized clinical trials that evaluated pharmacological intervention for antipsychotic-induced weight gain in the pediatric population. Non-peer-reviewed, non-human, non-English languages article was excluded. Metformin is the most studied medication for antipsychotic-induced weight gain in children. Three studies have shown that adding Metformin to the antipsychotics can significantly reduce the body weight and body mass index with mild transient side effects. Other adjunct medications like topiramate, amantadine, betahistine, or melatonin vary greatly in mitigating weight with various side effects. Lifestyle modification is the first step in dealing with AIWG, but the result is inconsistent. Avoiding the use of antipsychotic in children is preferred. Adding an adjuvant medication to the antipsychotic could prevent or mitigate their negative metabolic effect on the body weight and body mass index. Metformin has the most evidence, topiramate, betahistine, amantadine, and melatonin is possible alternatives in the pediatric patient without changing their antipsychotic medication. Other viable options show some benefits but need further clinical studies to establish efficacy and safety.
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Affiliation(s)
- Wisam Al Jumaili
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA.
| | - Ashraf Muzwagi
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
| | - Kaushal Shah
- Griffin Memorial Hospital-Oklahoma State University, Tulsa, OK, USA
| | - Chintan Trivedi
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
| | - Priya Durga
- Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
| | - Zeeshan Mansuri
- Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Shailesh Jain
- Regional Chair of Psychiatry Department, Texas Tech University Health Science Center at Permian Basin, Midland, TX, USA
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Bays HE, Lazarus E, Primack C, Fitch A. Obesity pillars roundtable: Phentermine - Past, present, and future. OBESITY PILLARS (ONLINE) 2022; 3:100024. [PMID: 37990729 PMCID: PMC10661986 DOI: 10.1016/j.obpill.2022.100024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2023]
Abstract
Background Phentermine is a sympathomimetic amine, approved for "short-term"treatment of patients with obesity. Among phentermine contraindications include use in patients with cardiovascular disease or patients with uncontrolled hypertension. Methods This roundtable discussion includes perspectives from 3 obesity specialists with experience in the clinical use of phentermine. The questions asked of the panelists were derived from publications regarding phentermine safety and efficacy. Results While the panelists generally agreed upon core principles of phentermine use, each obesity specialist had their own priorities and style regarding the administration of phentermine. Among the variances in perceptions (based upon their individual "real world" clinical experiences) included the degree of efficacy and degree of clinical benefit of phentermine, degree of concern regarding phentermine use in patients with cardiovascular disease risk factors, the advisability of a screening electrocardiogram, and the role of telehealth in prescribing phentermine and monitoring for the efficacy and safety of phentermine. Conclusions Providing universal guidance regarding phentermine treatment for obesity is challenging because of the lack of long-term, prospective, randomized, placebo-controlled, health outcomes data. Such data is unlikely forthcoming any time soon. Also challenging are the substantial variances in governmental restrictions on phentermine use. Therefore, clinicians are left to rely on the best available evidence, their individual practical clinical experience, as well as the collective clinical experiences of others - as reflected by this roundtable.
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Affiliation(s)
- Harold Edward Bays
- Diplomate of American Board of Obesity Medicine, Louisville Metabolic and Atherosclerosis Research Center, University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Ethan Lazarus
- Diplomate American Board of Obesity Medicine, Obesity Medicine Association Delegate to the American Medical Association, Clinical Nutrition Center, Greenwood Village, Colorado, USA
| | - Craig Primack
- Diplomate American Board of Obesity Medicine, Scottsdale Weight Loss Center, Scottsdale, AZ, 85258, USA
| | - Angela Fitch
- Diplomate American Board of Obesity Medicine, Medicine Harvard Medical School, Massachusetts General Hospital Weight Center, Boston, MA, 02114, USA
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Jo HS, Wang SM, Kim JJ. Recurrent Psychosis after Phentermine Administration in a Young Female: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:130-133. [PMID: 30690949 PMCID: PMC6361044 DOI: 10.9758/cpn.2019.17.1.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 11/18/2022]
Abstract
Phentermine is a sympathomimetic amine, like amphetamine, which is one of the most often prescribed drugs for weight loss. Although exact mechanism of phentermine causing psychosis is still not clear, numerous reports already showed that phentermine can induce psychosis. Psychotic symptoms are generally resolved once the medications are stopped. In contrast, we present a case of a 25-years-old Asian female patient who developed psychotic symptoms repeatedly after phentermine administrations. This case suggests that phentermine can cause psychotic episodes repeatedly, resulting in chronic occupational and social impairment. Therefore, a precautious measure such as government regulations for physicians prescribing and an education for patients taking phentermine are urgently needed.
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Affiliation(s)
- Hyun-Sic Jo
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,International Health Care Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Shettar V, Patel S, Kidambi S. Epidemiology of Obesity and Pharmacologic Treatment Options. Nutr Clin Pract 2017. [DOI: 10.1177/0884533617713189] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Sarang Patel
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Abstract
AIMS To describe the treatment of obesity from ancient times to present day. METHODS Articles reporting the development of anti-obesity therapies were identified through a search for 'anti-obesity' AND 'pharmacotherapy' AND 'development' within the title or abstract on PubMed and 'obesity' in ClinicalTrials.gov. Relevant articles and related literature were selected for inclusion. RESULTS Stone-age miniature obese female statuettes indicate the existence and cultural significance of obesity as long as 30,000 years ago. Records from Ancient Egyptian and Biblical eras through Greco-Roman to Medieval times indicate that obesity was present throughout the major periods of history, although peoples of previous centuries would probably have experienced overweight and obesity as exceptional rather than normal. Health risks of obesity were noted by the Greek physician Hippocrates (460-377 BCE) when the earliest anti-obesity recommendations on diet, exercise, lifestyle and use of emetics and cathartics were born. These recommendations remained largely unchanged until the early 20th century, when spreading urbanisation, increasingly sedentary jobs and greater availability of processed foods produced a sharp rise in obesity. This led to the need for new, more effective, ways to lose weight, to address comorbidities associated with obesity, and to attain the current cultural ideal of slimness. Drug companies of the 1940s and 1950s produced a series of anti-obesity pharmacotherapies in short succession, based largely on amphetamines. Increased regulation of drug development in the 1960s and new efficacy requirements for weight-loss drugs led to rapid reduction in anti-obesity therapies available by the early 1990s. CONCLUSION In the last two decades, several new and emerging therapies have been approved or are in development to provide safe, long-term pharmacological agents for the treatment of obesity.
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Affiliation(s)
- D Haslam
- The Cheyne Society, Datchworth, UK
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López-Canales JS, Lozano-Cuenca J, Muãoz-Islas E, Aguilar-Carrasco JC, López-Canales OA, López-Mayorga RM, Castillo-Henkel EF, Valencia-Hernández I, Castillo-Henkel C. Mechanisms involved in the vasorelaxant effects produced by the acute application of amfepramone in vitro to rat aortic rings. ACTA ACUST UNITED AC 2015; 48:537-44. [PMID: 25831200 PMCID: PMC4470313 DOI: 10.1590/1414-431x20144261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/11/2014] [Indexed: 02/02/2023]
Abstract
Amfepramone (diethylpropion) is an appetite-suppressant drug used for the treatment of overweight and obesity. It has been suggested that the systemic and central activity of amfepramone produces cardiovascular effects such as transient ischemic attacks and primary pulmonary hypertension. However, it is not known whether amfepramone produces immediate vascular effects when applied in vitro to rat aortic rings and, if so, what mechanisms may be involved. We analyzed the effect of amfepramone on phenylephrine-precontracted rat aortic rings with or without endothelium and the influence of inhibitors or blockers on this effect. Amfepramone produced a concentration-dependent vasorelaxation in phenylephrine-precontracted rat aortic rings that was not affected by the vehicle, atropine, 4-AP, glibenclamide, indomethacin, clotrimazole, or cycloheximide. The vasorelaxant effect of amfepramone was significantly attenuated by NG-nitro-L-arginine methyl ester (L-NAME) and tetraethylammonium (TEA), and was blocked by removal of the vascular endothelium. These results suggest that amfepramone had a direct vasorelaxant effect on phenylephrine-precontracted rat aortic rings, and that inhibition of endothelial nitric oxide synthase and the opening of Ca2+-activated K+ channels were involved in this effect.
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Affiliation(s)
- J S López-Canales
- Section of Postgraduate Studies and Investigation, Higher School of Medicine from the National Polytechnic Institute, Mexico City, Mexico
| | - J Lozano-Cuenca
- Department of Cellular Biology, National Institute of Perinatology, Mexico City, Mexico
| | - E Muãoz-Islas
- Department of Cellular Biology, National Institute of Perinatology, Mexico City, Mexico
| | - J C Aguilar-Carrasco
- Department of Cellular Biology, National Institute of Perinatology, Mexico City, Mexico
| | - O A López-Canales
- Section of Postgraduate Studies and Investigation, Higher School of Medicine from the National Polytechnic Institute, Mexico City, Mexico
| | - R M López-Mayorga
- Section of Postgraduate Studies and Investigation, Higher School of Medicine from the National Polytechnic Institute, Mexico City, Mexico
| | - E F Castillo-Henkel
- Section of Postgraduate Studies and Investigation, Higher School of Medicine from the National Polytechnic Institute, Mexico City, Mexico
| | - I Valencia-Hernández
- Section of Postgraduate Studies and Investigation, Higher School of Medicine from the National Polytechnic Institute, Mexico City, Mexico
| | - C Castillo-Henkel
- Section of Postgraduate Studies and Investigation, Higher School of Medicine from the National Polytechnic Institute, Mexico City, Mexico
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