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Sibutramine - a serotonin-norepinephrine reuptake-inhibitor for the treatment of obesity !

Sibutramine is an anti-obesity drug well accepted by patients. It has demonstrated efficacy in indusing and maintaining weight loss for up to two years.


Sibutramine has a dual mode of action in terms of weight control. It increases satiety and the feeling of fullness such that patients taking sibutramine may be able to reduce their portion sizes and thus be more in control of the amount of food they eat. There is also thought to be, at higher doses, an effect on energy expenditure. Indeed, part of the weight loss effect of sibutramine, particularly perhaps when it comes to weight maintenance, is attributed to the fact that it prevents the decline in energy expenditure that accompanies weight loss. This is thought to be a peripheral effect rather than a central effect of sibutramine.

Based on anorectic efficacy data, sibutramine, a serotonin-norepinephrine reuptake-inhibitor, is a viable therapeutic option for the treatment of obesity. Recommended candidates for this medication are patients with a body mass index (BMI)≥30 kg/m2 without concomitant risk factors or patients with a BMI≥27 kg/m2 with concomitant risk factors. Sibutramine should be used with caution in patients with a history of hypertension and should not be used in those with uncontrolled hypertension and concomitant cardiovascular disease.

Contraindications to sibutramine therapy are clear, as are situations in which it should be used with caution. Contraindications include anorexia nervosa, hypersensitivity to drug or ingredients, therapy with monoamine oxidase inhibitors or other serotonergic drugs, coronary heart disease, congestive heart failure, stroke, arrhythmia, uncontrolled hypertension, severe hepatic or renal disease, pregnancy, and lactation. Caution is advised in individuals younger than 18 years or older than 65 years and in those with a history of seizures and those who use other medications capable of raising blood pressure or with central actions. Initial weight loss is a good predictor for response. If patients have not experienced any weight loss within the first 4 to 6 weeks of therapy, sibutramine should be stopped.