We present a case report indicating that the administration of phentermine, an appetite suppressant with sympathomimetic activity, can provoke an intracerebral hemorrhage. A 48-year-old woman with no previously established cerebrovascular risk fa ctors and who had taken phentermine for 30 days developed sudden-onset left hemiparesis. Brain magnetic resonance imaging revealed an acute intracerebral hemorrhage involving the right thalamus. This case indicates that physicians should be aware of the relevant cause of medication history including appetite suppressants in young patients with an acute intracerebral hemorrhage.
Appetite Depressants ; Appetite* ; Brain ; Cerebral Hemorrhage* ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Paresis ; Phentermine* ; Thalamus

The published case series have suggested that appetite suppressants had some association with the development of stroke. Phendimetrazine is an appetite suppressant with sympathomimetic activity and it has a similar chemical structure with amphetamines. We report that a 22-year-old woman who had taken phendimetrazine for one month developed sudden right homonymous hemianopsia. MRI showed acute infarction in the territory of left posterior cerebral artery (PCA). Phendimetrazine should be considered as a cause of ischemic stroke.
Amphetamines ; Appetite Depressants ; Appetite* ; Female ; Hemianopsia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Posterior Cerebral Artery ; Stroke* ; Young Adult

OBJECTIVES: A retrospective case series study was conducted to investigate the clinical characteristics of psychotic disorders induced by appetite suppressants, phentermine and phendimetrazine. METHODS: A retrospective electronic medical record review identified 5 admitted patients who had psychotic symptoms after taking phentermine or phendimetrazine. Clinical information was reviewed and summarized in each case. RESULTS: Hallucinations were reported in all cases, including auditory, visual, olfactory and somatic hallucinations. After discontinuation of phentermine or phendimetrazine, the symptoms rapidly improved with low dose of antipsychotics. Patients tended to have less prominent negative symptoms and higher insight into illness, and often showed depressive mood. These clinical characteristics were similar to psychosis induced by amphetamines. Two patients developed stimulant use disorder while using phentermine. CONCLUSIONS: These findings call for awareness of the risks associated with use of appetite suppressants. Prescription of phentermine or phendimetrazine should be accompanied by close monitoring of mental status, and suspicion for substance/medication-induced psychotic disorder.
Amphetamines ; Antipsychotic Agents ; Appetite Depressants* ; Appetite* ; Electronic Health Records ; Hallucinations ; Humans ; Phentermine* ; Prescriptions ; Psychotic Disorders* ; Retrospective Studies ; Substance-Related Disorders

Phendimetrazine and related amphetamine-like compounds are used widely as appetite suppressants in Korea. We report on a patient who developed psychotic disorder and dependence while using phendimetrazine. A 25-year-old female with no psychiatric history began experiencing hallucination of bugs after using phendimetrazine for weight loss for five months. She was admitted and the drug was stopped. Three days later, her psychotic symptoms had subsided and she returned home. Two months after discharge, against medical advice, she returned to a clinic to obtain phendimetrazine for its anorectic effect. She continued using phendimetrazine because she had developed withdrawal symptoms and experienced cravings for it. Within two months of restarting the drug, she had developed paranoid delusions, auditory and olfactory hallucinations. She was readmitted, and was confirmed to have a dependence on phendimetrazine. This case provides a warning that amphetamine-related anorectics can cause psychotic disorder and dependence.
Adult ; Appetite Depressants ; Delusions ; Female ; Hallucinations ; Humans ; Korea ; Morpholines ; Psychotic Disorders ; Substance Withdrawal Syndrome ; Weight Loss

Obesity has become a major health problem worldwide. The prevalence and morbidity of obesity-related diseases including diabetes, hypertension, cerebro-cardiovascular diseases, and tumors also have remarkably increased. Treatment of obesity poses a challenge for clinicians. Anti-obesity treatment is helpful to improve and even reverse obesity-related complications. Diet control and physical exercises remain the predominant interventions for obese patients. Anti-obesity drugs can be considered in those who respond poorly to behavioral intervention or those who have developed obesity-related complications. The commonly used anti-obesity drugs include gastrointestinal lipase inhibitors and appetite suppressants. Glucagon-like peptide 1 has also been found to be effective in reducing body weight. Some more drugs are under development, which include selective 5-HT 2c agonist, β3 receptor agonist, and melanocortin receptor 4 agonist, may also be promising.
Anti-Obesity Agents ; therapeutic use ; Appetite Depressants ; therapeutic use ; Glucagon-Like Peptide 1 ; therapeutic use ; Humans ; Obesity ; drug therapy

Recently, obesity has become a worldwide public health concern and the use of anorectic drugs has drastically increased. In this study, sibutramine and phendimetrazine, representative marketed anorectics, were repeatedly administered per os on a daily basis into C57BL/6 mice and the effects of these drugs on food intakes, body weight changes and gene expression profiles were monitored for up to following 7 days. Methamphetamine, which has a potent anorectic effect, was used as a positive control. Anorectic effects were sustained only for two days by phendimetrazine or methamphetamine, but for six days by sibutramine. The modulations of gene expressions in the hypothalamus and the striatum were investigated using microarrays on day 2 and day 7 post-administration, which corresponded to the anorectic period and a return of appetite respectively, for all three drugs tested. Differences in overall gene expression profiles in the stratum on day 2 for sibutramine and phendimetrazine seems to reflect difference between the two in terms of the onsets of drug tolerance. According to microarray findings, the Ankrd26 gene appears to have an important anorectic role, whereas the up-regulation of the olfaction system appeared to be involved in the drug tolerance of anorectics. The microarray data presented in this study demonstrates the usefulness of gene expression analysis for gathering information on the efficacy and safety of anorectic drugs.
Animals ; Appetite ; Appetite Depressants ; Body Weight Changes ; Cyclobutanes ; Drug Tolerance ; Gene Expression ; Gene Expression Profiling ; Hypothalamus ; Methamphetamine ; Mice ; Morpholines ; Obesity ; Public Health ; Smell ; Transcriptome ; Up-Regulation

OBJECTIVES: Phenylpropanolamine (PPA) had been used widely as cold remedies or appetite suppressants. However, products containing PPA were withdrawn in sequence in the US, Japan, and Korea due to the increased risk of hemorrhagic stroke. The purpose of this paper was to review safety issues related with the PPA use and hemorrhagic stroke in view of pharmacoepidemiology and pharmacovigilance. METHODS AND MATERIALS: Researches conducted for evaluating the association between the PPA use and hemorrhagic stroke in other countries were reviewed, which involved case reports, case series, case-control studies, and cohort studies. RESULTS: In terms of pharmacologic and clinical features, PPA may increase the risk of hemorrhagic stroke through increased blood pressure, heart rate, or vasculitis. The association between the PPA use and hemorrhagic stroke among young women was suggested by case reports from spontaneous adverse events reporting systems or medical journals. The cohort study, using the large prescription database in the US and published in 1984, failed to reveal the association in the population aged below 65. The case-control study conducted as the Yale Hemorrhagic Stroke Project, published in 2000, was the first study to find the association between the PPA as appetite suppressants and hemorrhagic stroke among women ages 18-49 years by well-designed analytic epidemiological research. It led to withdrawal of all products containing PPA in the US and many other countries since 2000. However, the association between PPA and cerebral hemorrhage could not be confirmed by the case-control study conducted in Mexico due to inappropriate recruitment of control group. CONCLUSIONS: During several years case reports have suggested that hemorrhagic stroke could be induced by PPA, and the Yale Hemorrhagic Stroke Project revealed the association by case-control study and provided a useful model for pharmacovigilance. Nevertheless, their finding could not be applied to other population such as elderly women and male population. And they could not provide any evidence on the association between PPA and stroke when PPA was used as cold remedy taken daily dose below 100mg.
Aged ; Appetite Depressants ; Blood Pressure ; Case-Control Studies ; Cerebral Hemorrhage ; Cohort Studies ; Female ; Heart Rate ; Humans ; Japan ; Korea ; Male ; Mexico ; Pharmacoepidemiology ; Pharmacovigilance ; Phenylpropanolamine* ; Prescriptions ; Stroke* ; Vasculitis

The phentermine, an appetite suppressant, has been widely applied in Korea since 2004. However, there have been relatively few reports about the efficacy and the safety of phentermine in Korea. The aim of this study is to verify the effect of phentermine on weight reduction and the safety in Korean patients. This randomized, double-blind, placebo- controlled study had been performed between February and July, 2005, in Seoul on 68 relatively healthy obese adults whose body mass index was 25 kg/m2 or greater. They received phentermine-HCl 37.5 mg or placebo once daily with behavioral therapy for obesity. The primary endpoints were the changes of body weight and waist circumference from the baseline in the intention-to-treat population. Mean decrease of both body weight and waist circumference in phentermine-treated subjects were significantly greater than that of placebo group (weight: -6.7 +/- 2.5 kg, p < 0.001; waist circumference: -6.2 +/- 3.5 cm, p < 0.001). Significant number of subjects in phentermine group accomplished weight reduction of 5% or greater from the baseline and 10% or more (p < 0.001). There were no significant differences in systolic and diastolic blood pressure between the groups (p = 0.122 for systolic BP; p = 0.219 for diastolic BP). Dry mouth and insomnia were the only statistically significant adverse events that occurred more frequently in phentermine group. Most side effects of phentermine were mild to moderate in intensity. Short-term phentermine administration induced significant weight reduction and reduction of waist circumference without clinically problematic adverse events on relatively healthy Korean obese people.
Weight Loss/*drug effects ; Risk Factors ; Phentermine/administration & dosage/adverse effects/*therapeutic use ; Obesity/*drug therapy ; Male ; Korea ; Humans ; Female ; Double-Blind Method ; Appetite Depressants/administration & dosage/adverse effects/*therapeutic use ; Adult

According to WHO global estimates from 2008, more than 1.4 billion adults were overweight and among them, over 200 million men and 300 million women were obese. Although the main treatment modalities for overweight and obese individuals remain dieting and physical exercise, the synthetic anti-obesity medications have been increasingly used due to their perceived convenience. Generally, anti-obesity medications are classified as appetite suppressants or fat absorption blockers. In the present study, we examined the adverse side-effects in respect of behavior changes of phentermine and Ephedra sinica (mahuang) that are anti-obesity drugs currently distributed to domestic consumers. Phentermine is mainly classified as an anorexing agent and mahuang a thermogenic agent. Because phentermine and mahuang are considered to display effectiveness through the regulation of nerve system, their potential influences of on behavioral changes were examined employing animal experiments. From the results of experiments testing locomotor activity through the use of treadmill, rota-rod, and open field system, phentermine and mahuang were commonly revealed to induce behavioral changes of rats by reducing a motor ability, an ability to cope with an external stimulus, and a sense of balance or by augmenting wariness or excitement. These adverse effects of phenternime and mahuang in behavioral changes need to be identified in humans and anti-obesity medications such as phentermine and mahuang should be prescribed for only obesity where it is anticipated that the benefits of the treatment outweigh their potential risks.
Absorption ; Adult ; Animal Experimentation ; Animals ; Anti-Obesity Agents* ; Appetite Depressants ; Diet ; Diethylpropion ; Ephedra sinica ; Exercise ; Female ; Humans ; Male ; Models, Animal* ; Motor Activity ; Obesity ; Overweight ; Phentermine* ; Rats ; Rats, Sprague-Dawley*

OBJECTIVETo observe the effect of pBBADs-OXM-transformed bifidobacteria on the body weight of obese mice.

METHODSB. longum was transformed with pBBADs-OXM by electroporation, and arabopyranose-induced oxyntomodulin expression by the bacterium was detected by ELISA. pBBADs-OXM-transformed bifidobacteria was administered orally obese mice on a daily basis with pBBADs-GFP-transformed bifidobacteria as the negative control, and the body weight changes of the mice were observed.

RESULTSOXM was detected by ELISA not only in the supernatant but also the precipitant of the transformed bacterial culture. The body weight of the obese mice fed with pBBADs-OXM-transformed bifidobacteria decreased significantly compared with that of the mice in the obese model group (P<0.05).

CONCLUSIONAdministration of pBBADs-OXM-transformed B.longum can reduce the body weight of obese mice.

Administration, Oral ; Animals ; Appetite Depressants ; administration & dosage ; metabolism ; Bifidobacterium ; genetics ; metabolism ; Body Weight ; drug effects ; Electroporation ; Escherichia coli ; genetics ; metabolism ; Mice ; Obesity ; drug therapy ; Oxyntomodulin ; administration & dosage ; biosynthesis ; genetics ; Random Allocation ; Recombinant Proteins ; administration & dosage ; biosynthesis ; genetics