HONG KONG, June 1 (Reuters)
Doctors in Hong Kong have been prescribing a slimming drug indiscriminately to women desperate to lose weight, a group of pharmacists said on Friday, warning of an increased risk of stroke if the practice is not stopped.

The drug Phentermine, an appetite suppressant that acts on the central nervous system, has a chemical structure similar to that of the stimulant amphetamine and causes side effects including high blood pressure, palpitations and insomnia.

Pharmacists in Hong Kong say some family doctors have been loosely prescribing phentermine since 2004, even to women who obviously do not need to lose weight. Phentermine is prescribed two times more than a close alternative, sibutramine, which is patented and costlier, but which is considered safer and has fewer side effects, according to the Society of Hospital Pharmacists of Hong Kong. “We found out that family doctors are prescribing phentermine irrationally. It’s moving in the direction of abuse,” said William Chui, education director at the society. The society said between six and 10 thousand people on average were using phentermine each day.

To fight the side effects of phentermine, some doctors prescribe other drugs to lower blood pressure and heart rate, and help patients sleep. “Many doctors prescribe phentermine and then long-acting sleeping pills to fix the symptoms. Such sleeping pills can result in dependency. That’s unethical, especially when patients know nothing about drugs,” Chui said. “They also prescribe anti-hypertensive drugs to lower blood pressure which has been raised by the phentermine.” Chui warned of dire consequences. “Phentermine affects blood pressure and heart rate. If you have potential cardiovascular disease, it will worsen your condition. It can worsen your arrhythmia, and if your blood pressure increases, you can suffer from a stroke,” he said.

Sibutramine is known by its brand, Reductil. Phentermine is off-patent and costs a fraction of the patented sibutramine. Phentermine was part of a weight loss drug combo known as “fen-phen” (fenfluramine and phentermine) which was wildly popular during a diet craze in the United States in the 1990s. But the Food and Drug Administration banned fenfluramine, and a related drug, dexfenfluramine, in 1997 after studies linked them to heart valve damage. Fenfluramine and dexfenfluramine were made by Wyeth , which continues to be hounded by liability claims. Phentermine remains on the market.

The slimming craze has taken Asia by storm over the last decade. Classifed as health products, many brands of diet pills and teas — some containing controlled substances — are readily available in supermarkets in the region and on the Internet.

IT’S ALL ABOUT BUSINESS

“GPs don’t prescribe sibutramine because phentermine’s response is very quick. You can reduce up to 6 kg in 2-3 weeks. But Reductil cuts 2-4 kg in 1-2 months. That’s a huge difference. When you have quick fixes, you attract business,” he said. “It’s very obvious that doctors just want to make money.”

The U.S. FDA approves phentermine only for people who are obese, or with a Body Mass Index (BMI) of 30 and over. It must also be accompanied by exercise and proper diet control.

But some doctors in Hong Kong disregard these guidelines, Chui said. Some double the recommended dose of 15 milligrammes to quicken results, he said, contending that doctors rarely warned patients that they would recover the pounds they lost once they went off the controlled drug.

This practice came to light in 2004 when patients turned up in government hospitals complaining of various side effects. Henry Yeung, president of the Hong Kong Doctors’ Union, said doctors had to check patients’ BMI, state of health and inform them of side effects of drugs before making a prescription. “If management of a patient is inappropriate or falls short of standards, the medical council will look into it … but patients need to be sensible. They shouldn’t force doctors to go into grey areas (by demanding certain drugs),” Yeung said.

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June 1 (Reuters) - Weight-loss pills that suppress the appetite and block fat absorption are a significant part of the multibillion-dollar dieting industry that critics say should be better regulated.

Here are some facts on slimming drugs:

WHICH ARE THE MOST POPULAR?:

– Statistics are scarce as many drugs are unregulated.

– Two prescription drugs, orlistat, marketed by Roche under the brand Xenical, and sibutramine, marketed by Abbott as Reductil in the UK, and as Meridia in the U.S., are approved for use by the Food and Drug Administration

– Both are only prescribed for patients with a Body Mass Index (BMI) of 30 or more, or a BMI of 27 or more if they have other weight-related health problems

– Various non-prescription drugs and herbal supplements are available from the Internet, chemists or private “diet clinics” HOW DO PRESCRIPTION DIET DRUGS WORK?:

– Some are fat blockers or “lipase inhibitors”, like orlistat. They block fat-digesting lipase enzymes in the intestinal tract, so about a third of dietary fats are excreted before they are broken down into small molecules and absorbed.

– Others, like sibutramine, are appetite supressants or “satiety enhancers”. They block nerve cells that release and reabsorb serotonin, increasing serotonin levels and acting on the brain to promote the feeling of fullness. AND OTHER DIET DRUGS?:

– Over the counter drugs used for weight control range from diuretics, forcing the body to lose fluid; to stimulants, speeding up the heart rate and metabolism to burn fat more efficiently; and laxatives, stimulating the large bowel to empty before food and calories are absorbed via the small intestines.

– Some abuse other drugs to lose weight. Hollywood celebrities have reportedly turned to the ‘Size Zero Pill’ a steroid-like drug called Clenbuterol, legal only for horses, which burns fat by accelerating the heart rate and increasing body temperature.

HOW EFFECTIVE ARE THEY?:

– Generally, when taken in conjunction with a healthy diet and exercise, some are effective in the short term, experts say.

– Many over the counter pills are unregulated, and may be useless. Pills are also sometimes taken inappropriately, reducing their likely efficacy

– a 1998 study showed as many as a quarter of U.S. weight loss pill users were not overweight, for example.

– An International Journal of Obesity review found appetite suppressants were almost two times as effective as fat blockers: Orlistat gave an average 2.9 percent loss of body weight when taken for a year, and sibutramine resulted in a 4.6 percent loss over the same period. WHAT ARE THE RISKS?:

– All drugs carry health risks. Appetite suppressers have been linked with side effects like dry mouth, anorexia, insomnia and constipation and convulsions.

– Fat blockers, which also reduce the absorption of fat-soluble vitamins A, D, E and K, and beta-carotene, may be associated with increased defecation or fecal incontinence. DO MOST PEOPLE NEED TO LOSE WEIGHT?:

– Globally, there are more than 1 billion overweight adults, and at least 300 million of them are clinically obese, the World Health Organisation estimates.

– Being obese or overweight poses a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer.

– The U.S. weight loss market is worth at least US$40 billion, analysts say.

Sources: Anti-Obesity Forum (http://nationalobesityforum.org.uk/content/view/101/151/), Food and Drug Administration (www.fda.gov/bbs/topics/NEWS/2007/NEW01557.html), Phentermine (www.phentermine.com), the World Health Organisation (www.who.int/dietphysicalactivity/publications/facts/obesity/en/)

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