What is the primary definition of an anorectic?

An anorectic is a type of drug that functions to reduce a person's appetite. This reduction in appetite leads to decreased food consumption and, consequently, weight loss. These substances achieve this effect by influencing the central nervous system or specific neurotransmitters to induce a feeling of fullness or diminish the desire to eat.

How do anorectic substances typically work in the body?

Anorectic substances primarily work by affecting the central nervous system or specific neurotransmitters. These actions create a sensation of fullness or reduce the urge to eat, thereby leading to a decrease in food intake and potential weight loss. The mechanisms can involve complex neural signaling pathways.

What hormones are mentioned as being involved in appetite control in relation to anorectics?

The hormones identified as playing a role in appetite control, relevant to the understanding of anorexiant effects, include ghrelin, leptin, and peptide YY. These hormones are part of the body's complex system for regulating hunger and satiety.

Which neurotransmitters are significant in regulating food intake and are targeted by or related to anorectic effects?

Neurotransmitters such as serotonin and dopamine, which operate within the central nervous system, are significantly involved in regulating food intake. Their modulation is a key mechanism through which some anorectic drugs exert their effects.

What term is used to describe substances that stimulate appetite, in contrast to anorectics?

In contrast to anorectics, which reduce appetite, substances that stimulate appetite are referred to as orexigenic. This term signifies the opposite effect on the body's drive to consume food.

What is the etymological origin of the term 'anorectic'?

The term 'anorectic' originates from Ancient Greek. It is derived from 'an-' meaning 'without' and 'orexis' meaning 'appetite', literally translating to 'without appetite'. Other related terms include anorexigenic and anorexiant.

For what primary medical condition have anorectics been used clinically on a short-term basis?

Anorectics have been used clinically on a short-term basis primarily for the treatment of obesity. Their purpose in this context is to help manage weight by reducing food intake.

What types of ingredients are often found in appetite suppressants that are based on natural components?

Appetite suppressants based on natural ingredients frequently utilize green tea as a primary component. They are often combined with other plant extracts, such as fucoxanthin, which is naturally found in seaweed.

What is the chemical relationship between many appetite suppressants and amphetamines?

Many drugs classified as appetite suppressants are stimulants belonging to the phenethylamine family. This means they are chemically related to amphetamine, sharing similar structural characteristics.

How were amphetamines utilized by military forces during World War II?

During World War II, amphetamines were issued to soldiers by the German and Finnish militaries, notably under the brand name Pervitin. Similarly, the UK military received over 72 million Benzedrine tablets, and the US military received a comparable amount, to combat fatigue and maintain operational readiness.

What happened to amphetamine surpluses after World War II?

Following World War II, significant surpluses of amphetamines were redirected for use in both the black market and the civilian pharmaceutical market. Amphetamine itself was once commercially available as an appetite suppressant.

Why were amphetamines eventually outlawed for appetite suppression?

Amphetamines were outlawed in most parts of the world in the late 1950s due to safety concerns. These concerns included the potential for addiction, as well as side effects like tachycardia (rapid heart rate) and hypertension (high blood pressure), which made prolonged unsupervised use dangerous.

What serious public health issues have been linked to pharmaceutical anorectic agents?

Pharmaceutical anorectic agents have been linked to serious public health concerns, including epidemics of fatal pulmonary hypertension and damage to heart valves. These issues led to the withdrawal of several products from the market.

Can you name specific anorectic drugs that were withdrawn due to public health concerns?

Yes, several anorectic drugs have been withdrawn due to significant health risks. Aminorex was withdrawn in the 1960s, and fenfluramine (a component of Fen-phen) was withdrawn in the 1990s due to risks of pulmonary hypertension and heart valve damage. Phenylpropanolamine was also requested for withdrawal by the FDA due to its association with hemorrhagic stroke.

What led to the withdrawal of lorcaserin from the market in the United States?

Lorcaserin was withdrawn from the market in the United States by the Food and Drug Administration (FDA) due to an increased risk of cancer associated with its use. This highlights the ongoing monitoring of drug safety after initial approval.

What concerns led to the FDA's request for the withdrawal of phenylpropanolamine?

The Food and Drug Administration (FDA) requested the withdrawal of phenylpropanolamine from the market in the United States in 2000 because of its association with hemorrhagic stroke. This indicated a serious risk of cerebrovascular events.

What was the rationale behind the FDA's ban on ephedrine in dietary supplements in 2004?

The FDA banned the inclusion of ephedrine in dietary supplements in 2004 due to health concerns. However, it is also debated whether this ban was partly influenced by ephedrine's use as a precursor in the illicit manufacture of methamphetamine, rather than solely health concerns.

What non-pharmacological approach has been researched for appetite suppression and weight loss?

Drinking water has been researched as a potential non-pharmacological approach for appetite suppression and weight loss. Studies suggest that consuming water before meals may contribute to reduced food intake and modest weight loss.

What specific findings exist regarding the consumption of water before meals for weight loss?

Research indicates that drinking 500 mL (approximately 17 fluid ounces) of water 30 minutes before meals has been correlated with modest weight loss, typically between 1-2 kg (2.2-4.4 lbs), over an 8 to 12-week period in obese individuals. This suggests a simple behavioral intervention can aid weight management.

What is refeeding syndrome (RFS)?

Refeeding syndrome (RFS) is a metabolic disturbance that occurs when nutrition is reintroduced to individuals who have been starved, are severely malnourished, or are metabolically stressed due to severe illness. It is a potentially dangerous condition that requires careful management.

What causes refeeding syndrome?

Refeeding syndrome is caused by the rapid reinstitution of nutrition, particularly carbohydrates, after a period of malnutrition or starvation. This rapid influx of nutrients triggers a surge in metabolic processes, including the production of glycogen, fat, and protein, which depletes essential electrolytes.

Which electrolytes become depleted during refeeding syndrome?

During refeeding syndrome, the rapid metabolic activity leads to low serum concentrations of key electrolytes, specifically potassium, magnesium, and phosphate. These imbalances are central to the dangerous complications of RFS.

What are the potential consequences of the electrolyte imbalances seen in refeeding syndrome?

The electrolyte imbalances resulting from refeeding syndrome can lead to a range of severe symptoms affecting multiple body systems. These include neurologic, pulmonary, cardiac, neuromuscular, and hematologic symptoms, which can be fatal if severe enough.

When does refeeding syndrome typically begin to manifest?

Refeeding syndrome can occur when an individual who has not eaten for several days begins to reintroduce food or nutritional supplements. Symptoms typically begin to appear within the initial four to seven days following the period of malnutrition, often starting around day 4 or 5 without food.

Are there specific groups of individuals at increased risk for refeeding syndrome?

Yes, individuals with substance abuse issues who are reintroducing normal eating habits after a period of malnutrition may be at an increased risk for developing refeeding syndrome. Their nutritional status can be precarious, making them more vulnerable to metabolic shifts.

What is the ATC classification for anorectics?

Anorectics are classified under the Anatomical Therapeutic Chemical (ATC) Classification System as 'centrally-acting antiobesity preparations' with the code A08AA.

List some of the amphetamine and phenethylamine-related anorectics mentioned in the ATC classification.

The ATC classification lists several amphetamine and phenethylamine-related anorectics, including Amfepramone (diethylpropion), Cathine, Clobenzorex, Dexfenfluramine, Etilamfetamine, Fenfluramine, Mefenorex, Phentermine, and Sibutramine. Bupropion and naltrexone are also listed as a combination.

Which anorectic drug listed under ATC was withdrawn due to cancer risk?

Lorcaserin, listed under the ATC classification, was withdrawn in the United States by the FDA due to an increased risk of cancer. This highlights a significant safety concern that led to its removal from the market.

What are the reasons cited for the withdrawal of Sibutramine and Fenfluramine?

Sibutramine was withdrawn from the market in some countries due to concerns regarding its cardiovascular effects. Fenfluramine, one of the components of the Fen-phen combination, was discontinued due to its potential to cause valvulopathies (heart valve disease) and pulmonary hypertension.

Which anorectic drug listed under MeSH was removed from the market by the EMA due to increased risk of heart disease?

Benfluorex, listed under MeSH as an appetite depressant, was removed from the market by the European Medicines Agency (EMA) due to an increased risk of heart disease. This action was taken to protect public health from known cardiac risks.

What is Phenmetrazine known for, leading to its withdrawal in some countries?

Phenmetrazine, listed under MeSH, was withdrawn in some countries due to the danger of addiction. This indicates its potential for abuse and dependence was a primary reason for regulatory action.

Which common stimulant is known to hamper appetite and is used for ADHD?

Amphetamine-Dextroamphetamine is known to hamper appetite and is used to treat Attention Deficit Hyperactivity Disorder (ADHD). It is commonly recognized by trade names such as Adderall or Mydayis.

What is Amphetamine sulfate approved for by the US FDA, and under what brand name?

Amphetamine sulfate, also known as amfetamine, is approved by the US FDA for the treatment of exogenous obesity. It is marketed under the brand name Evekeo for this indication.

Which substance, known for its stimulant properties, is also listed as having appetite suppressant activity?

Cocaine, a well-known stimulant, is also listed as a compound with appetite suppressant activity. Its pharmacological effects can include a reduction in appetite.

What is Glucomannan, and what is its role regarding appetite?

Glucomannan is a dietary fiber derived from the konjac plant. It is listed as having appetite suppressant activity, likely due to its ability to absorb water and swell in the stomach, promoting a feeling of fullness and potentially delaying gastric emptying.

What are Liraglutide and Semaglutide, and what are their brand names?

Liraglutide is a GLP-1 agonist used as an appetite suppressant, marketed under the brand name Saxenda. Semaglutide, also a GLP-1 agonist, is available under the brand names Ozempic and Wegovy and also exhibits appetite suppressant properties.

What is Tirzepatide, and what are its brand names?

Tirzepatide is a medication that acts as a dual GIP and GLP-1 receptor agonist. It is marketed under the brand names Mounjaro and Zepbound and is recognized for its effects on weight management, including appetite suppression.

Are opiates or opioids considered to have appetite suppressant activity?

Yes, opiates and opioids, such as heroin, morphine, codeine, oxycodone, and fentanyl, are listed as compounds with appetite suppressant activity. This is one of their known pharmacological effects, alongside their pain-relieving and addictive properties.

What is the primary function of the MeSH (Medical Subject Headings) index in relation to anorectics?

The MeSH index serves as a catalog of medical literature, and it lists various compounds with appetite suppressant activity. This index helps researchers and clinicians identify relevant studies and substances related to appetite control.

What is the purpose of the 'See also' section in the article?

The 'See also' section typically lists related topics or concepts that a reader might find relevant for further exploration. In this case, it points to 'Anti-obesity medication,' which is a broader category encompassing anorectics and other weight-management drugs.

What is the significance of the dagger symbol (†) next to some drug names in the list of anorectics?

The dagger symbol (†) next to certain drug names, such as Dexfenfluramine, Fenfluramine, Sibutramine, Cagrilintide/semaglutide, Semaglutide, and Tirzepatide, indicates that these drugs have been withdrawn from the market. This symbol serves as a warning about their regulatory status due to safety or efficacy concerns.

What does the symbol ‡ signify in the list of anorectics?

The symbol ‡, appearing next to drugs like 4-Methylamphetamine, Ephedra, Furfenorex, Aminorex, Benfluorex, Dexfenfluramine, Difemetorex, Fenfluramine, Sibutramine, and Rimonabant, indicates that these substances have been withdrawn from the market. This is a crucial piece of information regarding their availability and safety.

What is the role of the Navbox 'Antiobesity agents/Anorectics (A08)'?

The Navbox 'Antiobesity agents/Anorectics (A08)' provides a structured overview and navigation tool for related substances. It categorizes various drugs used for weight management, including stimulants, cannabinoid antagonists, GLP-1 agonists, and others, facilitating exploration of the topic.

Within the Navbox, what categories are used to classify antiobesity agents?

The Navbox classifies antiobesity agents into several categories, including Stimulants (further divided into Amphetamines and phenethylamines, Adrenergic agonists, and Other), Cannabinoid antagonists, GLP-1/GIP/glucagon agonists, DACRAs (Dual amylin and calcitonin receptor agonists), 5-HT2C receptor agonists, Absorption inhibitors, Uncouplers, and a category for 'Others'.

What does the symbol § signify in the Navbox list of anorectics?

The symbol §, used for drugs like Clenbuterol, Drinabant, Ibipinabant, Otenabant, Rosonabant, Surinabant, Taranabant, Oxyntomodulin, Beloranib, Bimagrumab, and Setmelanotide, indicates that these drugs have either never progressed to Phase III clinical trials or have been discontinued before that stage. This suggests they may not have demonstrated sufficient efficacy or safety for widespread use.

What is the purpose of the Authority Control databases section at the end of the article?

The Authority Control section provides links to standardized identifiers in various databases (like GND, Library of Congress, National Library of Israel, and Yale LUX). These identifiers help ensure consistency and accuracy when referencing the topic 'anorectic' across different information systems and catalogs.

How do hormones like leptin and ghrelin relate to appetite regulation?

Leptin and ghrelin are key hormones involved in the complex regulation of appetite and body weight in humans. Leptin generally signals satiety (fullness), while ghrelin is known as the 'hunger hormone' as it stimulates appetite. Understanding their roles is crucial for developing interventions for weight management.

What is the significance of drugs like Liraglutide and Semaglutide in modern weight management?

Liraglutide (Saxenda) and Semaglutide (Ozempic/Wegovy) represent a newer class of anti-obesity medications known as GLP-1 receptor agonists. These drugs mimic a natural gut hormone to help regulate appetite, improve blood sugar control, and promote significant weight loss, marking a notable advancement in pharmacotherapy for obesity.

Anorectic Wiki: The Appetite Equation: Understanding Anorectic Agents and Their Mechanisms

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Introduction to Anorectics

Defining Appetite Control

An anorectic is a pharmacological agent designed to reduce appetite, thereby leading to decreased food consumption and subsequent weight loss. These substances exert their effects primarily by influencing the central nervous system or specific neurotransmitters, inducing a sensation of fullness or diminishing the drive to eat.

Mechanisms of Action

The understanding of anorexiant effects is critical for developing interventions in weight management and related health conditions. Anorectic mechanisms can be diverse, involving hormonal regulation and neural signaling. Key hormones such as ghrelin, leptin, and peptide YY play roles in appetite control, complemented by neurotransmitters like serotonin and dopamine within the central nervous system that significantly regulate food intake.

Orexigenic vs. Anorectic

Conversely, substances that stimulate appetite are termed orexigenic. The term "anorectic" itself originates from the Greek words "an-" (without) and "orexis" (appetite), literally meaning "without appetite." These agents are also referred to as anorexigenic or appetite suppressants.

Historical Context

Early Clinical Use and Diversion

Historically, anorectic drugs were employed for short-term clinical management of obesity. Some were available over-the-counter, often formulated with natural ingredients like green tea extract and fucoxanthin. Many of these early suppressants were stimulants derived from the phenethylamine family, closely related to amphetamine.

Wartime and Post-War Applications

During World War II, amphetamines such as Pervitin were issued to soldiers by German and Finnish militaries to combat fatigue. Similarly, the UK and US militaries received substantial quantities of Benzedrine tablets. Following the war, surplus amphetamines were channeled into the black market and civilian use, including as appetite suppressants, before widespread bans were enacted due to safety concerns like addiction, tachycardia, and hypertension.

Public Health Concerns

Cardiovascular Risks

Epidemics of severe cardiovascular conditions, including fatal pulmonary hypertension and heart valve damage, were linked to pharmaceutical anorectic agents. This led to the market withdrawal of drugs like aminorex in the 1960s and fenfluramine (as part of Fen-phen) in the 1990s.

Neurological and Regulatory Issues

The association of phenylpropanolamine with hemorrhagic stroke prompted the U.S. FDA to request its withdrawal in 2000. Concerns regarding ephedrine's use as a precursor in methamphetamine manufacture also contributed to regulatory actions, although its ban in dietary supplements was later challenged. These events underscore the complex balance between therapeutic effects and potential adverse outcomes.

Non-Pharmacological Approaches

The Role of Water Consumption

Research has explored non-pharmacological methods for appetite suppression, notably the consumption of water. Studies suggest that drinking approximately 500 mL of water 30 minutes prior to meals may contribute to modest weight loss over a 12-week period in adults. This simple intervention appears to aid in appetite suppression by increasing satiety.

Refeeding Syndrome

Metabolic Disturbances

Refeeding syndrome (RFS) is a critical metabolic disturbance occurring when nutrition is reintroduced to individuals who have been starved, severely malnourished, or are metabolically stressed due to illness. Rapid reintroduction of nutrients can lead to potentially fatal shifts in fluid and electrolytes, including low serum concentrations of potassium, magnesium, and phosphate.

Risk Factors and Consequences

RFS typically manifests after 4-5 days without adequate caloric intake. Individuals with substance abuse disorders who are reintroducing normal eating patterns after a period of malnutrition are at increased risk. The resulting electrolyte imbalances can trigger severe neurological, cardiac, neuromuscular, and hematologic symptoms.

Anorectic Agents: A Detailed List

Central Nervous System Stimulants

Many anorectic agents function as stimulants, primarily affecting the central nervous system. These are often classified under the Anatomical Therapeutic Chemical (ATC) Classification System code A08AA.

The following are listed as centrally-acting antiobesity preparations:

Amfepramone (also known as diethylpropion)
Bupropion and naltrexone (combination)
Cathine
Clobenzorex
Dexfenfluramine^‡ (withdrawn)
Ephedrine (combinations)
Etilamfetamine
Fenfluramine^‡ (withdrawn due to cardiovascular risks)
Lorcaserin (withdrawn in the US due to cancer risk)^‡
Mazindol
Mefenorex
Phentermine
Sibutramine^‡ (withdrawn in some countries)
Topiramate

^‡ Indicates drugs withdrawn from the market.

MeSH and Other Agents

The Medical Subject Headings (MeSH) index and other pharmacological data identify a broader range of compounds with appetite suppressant activity.

Agents listed by MeSH:

Benfluorex (removed from market)^‡
Butenolide
Diethylpropion
FG-7142
Phenmetrazine^‡ (withdrawn in some countries)
Phentermine
Phenylpropanolamine
Pyroglutamyl-histidyl-glycine
Sibutramine

Other compounds with known appetite suppressant activity:

Amphetamine-Dextroamphetamine (e.g., Adderall)
Amphetamine sulfate (e.g., Evekeo)
Methylphenidate
Cocaine
Caffeine
Glucomannan
Leptin
Lisdexamfetamine (e.g., Vyvanse)
Methamphetamine hydrochloride (e.g., Desoxyn)
Nicotine
Liraglutide (e.g., Saxenda)
Semaglutide (e.g., Ozempic/Wegovy)
Tirzepatide (e.g., Mounjaro/Zepbound)
Metformin
Opiates/opioids (e.g., heroin, morphine, codeine, oxycodone, fentanyl)

^‡ Indicates drugs withdrawn from the market or with significant safety concerns.

Broader Pharmacological Classes

Anorectic effects are also observed within broader drug classes, including those targeting specific receptor systems or metabolic pathways.

Stimulants: Amphetamines and phenethylamines (e.g., 4-Methylamphetamine, Amfepramone, Amphetamine, Cathine, Clobenzorex, Dextroamphetamine, Ephedrine, Fenproporex, Lisdexamfetamine, Mefenorex, Methamphetamine, Phentermine).

Adrenergic agonists: (e.g., Albuterol, Clenbuterol^§, Ephedrine, Synephrine, Yohimbine).

Cannabinoid receptor antagonists: (e.g., Rimonabant^‡, Otenabant^§).

GLP-1, GIP, and Glucagon agonists: (e.g., Semaglutide, Tirzepatide^†, Liraglutide, Retatrutide).

DACRAs (Dual Amylin and Calcitonin Receptor Agonists): (e.g., Cagrilintide).

5-HT2C receptor agonists: (e.g., Lorcaserin^‡).

Absorption inhibitors: (e.g., Orlistat, Cetilistat).

Uncouplers: (e.g., 2,4-Dinitrophenol^‡).

Other agents: Metformin, Naltrexone, Topiramate, Zonisamide, Water.

^† Phase III clinical trial. ^§ Never progressed beyond early clinical trials. ^‡ Withdrawn from market.

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The Appetite Equation

💡 Dive in with Flashcard Learning! 💡

Introduction to Anorectics 🔬

🍽️ Defining Appetite Control

🧠 Mechanisms of Action

⚖️ Orexigenic vs. Anorectic

Historical Context 📜

🕰️ Early Clinical Use and Diversion

⚔️ Wartime and Post-War Applications

Public Health Concerns ⚠️

💔 Cardiovascular Risks

🧠 Neurological and Regulatory Issues

Non-Pharmacological Approaches 💧

🥤 The Role of Water Consumption

Refeeding Syndrome 🏥

📉 Metabolic Disturbances

⚠️ Risk Factors and Consequences

Anorectic Agents: A Detailed List 💊

A08 Central Nervous System Stimulants

📚 MeSH and Other Agents

🌐 Broader Pharmacological Classes

References 📚

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📜 Important Notice

Dive in with Flashcard Learning!

Introduction to Anorectics

Defining Appetite Control

Mechanisms of Action

Orexigenic vs. Anorectic

Historical Context

Early Clinical Use and Diversion

Wartime and Post-War Applications

Public Health Concerns

Cardiovascular Risks

Neurological and Regulatory Issues

Non-Pharmacological Approaches

The Role of Water Consumption

Refeeding Syndrome

Metabolic Disturbances

Risk Factors and Consequences

Anorectic Agents: A Detailed List

Central Nervous System Stimulants

MeSH and Other Agents

Broader Pharmacological Classes

References

Test Your Knowledge

Interactive Quiz

Teacher's Corner

True or False?

Test Your Knowledge!

Gamer's Corner

Discover other topics to study!

References

Feedback & Support

Disclaimer

Important Notice