Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.
Which is easier: gain weight or lose weight? Of course, getting better is much more difficult, and sometimes it is simply impossible. It is easier to increase your weight after a serious illness, for example, after pneumonia or tuberculosis, if, of course, the person's weight was higher before that. After all, the body has a genetic memory. But if a person was originally a thin physique, and all his relatives, too, then it is sometimes very difficult to gain weight for him. The organism, according to the second law of thermodynamics, as an open system, tries to move to the state with the lowest energy. Therefore, he tries to get rid of excess energy without transferring it into mass and without spending his own strength. This can be done by increasing metabolism, slightly increasing body temperature, activating thyroid hormones, and finally by reducing intestinal absorption.
Therefore, compared to those who want to gain weight, who want to lose weight, and cure obesity, in general, from the point of view of physics, nothing needs to be done. Losing weight is much easier than gaining weight. There is only one very important but simple principle to be followed. Daily energy consumption should be slightly less than its costs.
But, alas, obesity is a social scourge of humanity. Obesity is not just a disease or addiction, but a global epidemic. So, by 2010, about one and a half billion adults were overweight. More than 200 million men and 300 million women have had clinical forms of obesity, and there is a constant and alarming trend towards an increase in the frequency of this pathological condition in the civilized population.
It is necessary to treat obesity, but, as in many cases of metabolic disorders, the use of drugs and tablets should be in the last place, after all non-drug methods have been tried. Naturally, you need to start with diet and lifestyle modifications, then connect to an increase in physical activity, and only then turn to drugs and drugs for obesity.
Strictly speaking, in a natural, physiological way, they converted excess body weight into energy throughout the history of human civilization. However, the development of medical science has constantly offered improved ways to combat obesity, because it is common for a person not to work on himself, not to test his willpower, but simply to use certain drugs, following the path of 'least resistance'. Therefore, doctors met halfway, gradually began to use laxatives, and then – and the use of thyroid hormones.
This method of treatment was very rough and consisted in increasing the basal metabolism, but there were significant side effects associated with the appearance of a clinic of hyperthyroidism. In the thirties of the XX century, amphetamines appeared, which are prohibited in our country, but they perfectly suppress appetite and increase physical activity, causing euphoria. However, the use of amphetamines is fraught with subsequent serious disorders, which, first of all, are expressed in a complete breakdown, the development of depression and the formation of addiction.
Research on the effect of various drugs on lipid metabolism in order to find a safe and effective drug for weight loss is ongoing. There are already medicines that can enhance metabolism, prevent fat absorption, stimulate insulin production, and improve mood. But until now, all these drugs can reduce food intake, or make its energy intake less beneficial. Still, the cornerstone remains the creation of a substance that would control weight by reducing appetite, and not cause side effects associated with shifts in metabolism.
Appetite is not just a feeling or a desire. Satisfying the feeling of hunger is a deep and ancient instinct, which, along with satisfying the feeling of thirst, is in the first place among all aspirations and interests, except for the instinct of self-preservation. In order to get enough and survive, a person must take a number of specific actions. Therefore, the neural mechanism underlying appetite and its satisfaction is extremely complex. In clinical practice, such drugs were tested and used that reduced and even completely suppressed appetite, but they all had a high risk, up to deaths, and could not be used to treat obesity.
The situation is further exacerbated by the fact that the accumulated with great difficulty reserves of fat in the human body are protected from irrational use, and are stored in reserve. Our fat stores are protected by hormones, enzymes, and behavioral changes.
Therefore, at present, there is still no single and complete drug that is guaranteed to allow you to lose weight without changing your lifestyle and diet, and would not have any contraindications for use. Perhaps the closest to this is RDT, or therapeutic fasting. However, there are a number of medicines that can be used in short courses strictly according to the doctor's indications, along with gymnastics, diet, increased physical activity and other known methods of reducing body weight. Very few products can be used safely for a long time, for a year or longer. Let's consider some groups of drugs that are used in our country, as well as abroad, to reduce body weight.
- Obesity drugs
- Review of popular drugs for the treatment of obesity
- Digestive blockers – Orlistat (Xenical, Xsenalten, Orsoten)
- Hormonal stimulants of insulin production: liraglutide (Victoza, Saxenda)
- Metformin (Glyformin, Glucophage, Siofor, Formitin)
- Byeta, Byeta-Long (exenatid)
- Sibutramine (Meridia, Reduxin, Slimia, Goldline Plus)
- About prospects and foreign drugs
- Rimonabat (Akomplia, Zimulti)
- Lorcaserin (Belvik)
- Ximia (phentermine + topiramate)
There are very few such drugs, and almost each of them is the only representative from its group. Among the drugs for the treatment of obesity, or rather, allowing you to slightly reduce body weight, we will not find a great abundance of drugs. If we turn to pharmacology, then there are whole series and generations of drugs, for example, such as non-steroidal anti-inflammatory drugs (NSAIDs). These are meloxicam and nimesulide, ketoprofen and celecoxib, paracetamol and diclofenac. They are all effective, but completely different.
The same variety can be found among hormonal drugs, among cough suppressants, among antiulcer drugs, and among headache drugs. But for the treatment of obesity, unfortunately, the desired abundance has not yet been found. In the event that the drug is used in Russia, then commercial names are given for it, as well as the price range that is relevant for the fall of 2019.
All drugs are arranged according to their mechanism of action. In the proposed list, there is no rating, no ranking for possible effectiveness. The order is arbitrary.
Before describing drugs, it should be reminded that self-medication is dangerous, and an attempt to use these drugs without a doctor's prescription can result in a serious illness. In addition, even a doctor, and a specialist in the field of nutrition and overweight treatment, will definitely try non-drug methods before using medications. And only then, in the absence of a result, some drugs listed below can be prescribed.
Like many drugs, they have a number of side effects, such as agitation, insomnia, high blood pressure, and a tendency to chronic diarrhea.
Review of popular drugs for the treatment of obesity
|Nomination||a place||Name of product||price|
|Obesity drugs||1||Digestive blockers – Orlistat (Xenical, Xsenalten, Orsoten)||759 r|
|2||Hormonal stimulants of insulin production: liraglutide (Victoza, Saxenda)||RUB 9,200|
|3||Metformin (Glyformin, Glucophage, Siofor, Formitin)||168 RUB|
|4||Byeta, Byeta-Long (exenatid)||RUB 3450|
|Antidepressants||1||Sibutramine (Meridia, Reduxin, Slimia, Goldline Plus)||RUB 2,035|
|About prospects and foreign drugs||1||Rimonabat (Akomplia, Zimulti)||–|
|2||Lorcaserin (Belvik)||RUB 18,240|
|3||Ximia (phentermine + topiramate)||–|
Digestive blockers – Orlistat (Xenical, Xsenalten, Orsoten)
A drug that impairs the absorption of fat in the intestines is perhaps the most harmless drug used to treat obesity. For example, in the United States, you can buy this drug without a prescription, and all other drugs for the treatment of obesity will be prescription. What is this drug? This is Xenical, or Orlistat.
It is known that normally the pancreas produces a special enzyme that breaks down fats (pancreatic lipase), and bile, which is produced by the liver, helps these fats emulsify and transfer them into a convenient phase for lipase action. Therefore, in the event that this lipase is somehow inactivated, then the fats supplied with food will not be broken down in the intestine, but will be excreted unchanged with feces.
If Xenical is used in therapeutic, recommended dosages, then the absorption of fats in the intestine is reduced by a third, and the metabolism does not change. As a result of a decrease in the flow of fats into the blood, the body's ability to store them as a reserve in adipose tissue decreases. There are many clinical studies, with the help of which it was revealed that the use of this drug without changing the diet and without physical activity allowed patients to reduce an average of about 6 kg of weight in 4 years. Naturally, this suggests that the drug works, but if a person monitors the diet and increases his physical activity, then the same number of kilograms can be lost not in 4 years, but in 4 months, and even faster, without harm to health .
Xenical, or Orlistat, has a fearless but unpleasant side effect. If fat is not absorbed, it must be excreted in the feces. And if the feces contain an excessive amount of fat, then the fat, accumulating on the walls of the colon, will cause its mechanical irritation, and fatty stools will literally slide outward along the surface of the intestine. This phenomenon of steatorrhea is well known to patients with chronic pancreatitis. For them, due to a lack of enzymes, fatty stools constantly lead to the need to use a brush in the toilet, since fat is not easily washed off with water.
But from the use of Xenical there is an additional positive effect that is not associated with a decrease in body weight. Reducing the amount of absorbed fat leads to a drop in total cholesterol levels, and reduces the risk of atherosclerosis. But again, it is much more effective to reduce the risk of atherosclerosis and reduce the concentration of cholesterol in the blood plasma through diet and increased physical activity.
On the Russian market, Xenical is represented by the Italian company Roche, and a pack of 21 tablets will cost an average of 950 rubles. Krka's Orsoten will cost slightly less, about 800 rubles. It is necessary to use this remedy one capsule at a time with a meal. Therefore, if we accept that a person eats three times daily, then one package will be enough for a week, and a monthly course will cost 4000 rubles.
Hormonal stimulants of insulin production: liraglutide (Victoza, Saxenda)
Strictly speaking, among the official indications of liraglutide, there is no recommendation to use it for weight loss. It is prescribed for patients with type 2 diabetes mellitus to normalize blood sugar levels when other drugs are ineffective. The second indication is to reduce the risk of heart attack and stroke in patients with the same type 2 diabetes mellitus against the background of any cardiac pathology, as a means of additional treatment. But in the US, liraglutide is still used to reduce body weight, although also in patients with type 2 diabetes. Unlike other medicines, these are not tablets or capsules, or even drops, but a preparation for subcutaneous injection.
Liraglutide is similar to the human glucagon-like peptide. To create it, it took the help of genetic engineering and biotechnology. The corresponding section of human DNA, which codes for the synthesis of this peptide, was inserted into the hereditary material, ordinary yeast, then this yeast multiplied and began to produce this human substance in the factory. As a result, liraglutide was obtained, which after purification has 97% similarity to the human peptide. As a result of its connection with receptors, insulin secretion is stimulated, and the barrier of insulin resistance is overcome. This drug must be used subcutaneously. On their own, at home, they put an injection in the shoulder, abdomen, or thigh once a day as they like, regardless of the meal. But still, it's better to put it at the same time of day.
How much can you lose weight? According to existing studies, it took more than a year, as much as 14 months, or an interval of 56 weeks, for the average decrease in body weight in patients with diabetes to a maximum of 8.5 kg to be reliably established. On the one hand, this figure can really amaze and interest. But on the other hand, you should first find out about the cost of this drug. So, the drug Victoza, which is produced by Novo Nordisk from Denmark, costs, on average, 10,000 rubles. This is the cost of a two-day treatment. The same drug Saxenda, which is produced by the same company, will cost, on average, 25,000 rubles. for five syringe pens, that is, for the cost of a five-day treatment. Accordingly, the cost of treatment with liraglutide for 56 weeks will cost the patient almost 2 million rubles. Therefore, it is still much easier for healthy people to reduce body weight in the gym or in the pool, or simply limit the amount of fat supplied with food, than to pay that kind of money.
There is one more very important circumstance. This medication is only for people with diabetes. If liraglutide is used by people with normal blood sugar levels, then insulin induction can lead to a drop in sugar, the development of hypoglycemia, and even a coma. There are a large number of contraindications, drug interactions with other drugs, and even an endocrinologist should be trained to work with this drug and have experience in prescribing it.
Metformin (Glyformin, Glucophage, Siofor, Formitin)
The second drug intended for the treatment of type II diabetes mellitus, which, we emphasize, as a side effect leads to a decrease in body weight in patients, is metformin. But, as in the previous case, it cannot be used to treat obesity in people without type 2 diabetes, and moreover: if the patient takes metformin, but he is diagnosed with type 1 diabetes, then this medicine is simply dangerous to take.
But if a patient with type 2 diabetes is overweight, then when metformin is taken correctly, weight loss begins to work, while the risk of hypoglycemia or a drop in blood sugar is negligible. Metformin is contraindicated in severe renal pathology and chronic renal failure, with heart, liver, respiratory failure, dehydration, chronic alcoholism. Siofor 850 mg in tablets, 60 tablets each (Berlin Chemi company) will cost inexpensively, from 260 to 370 rubles, Domestic Glyformin, produced by Akrihin, will cost even less – a maximum of 120 rubles. per package (500 mg No. 60).
Byeta, Byeta-Long (exenatid)
Another analogue of a glucagon-like peptide can be the drug Byetta-Long, Exenatide. The difference between Baeta-Long and liraglutide can be considered the need not to inject the drug daily under the skin, but once a week. In addition, Exenatide can be used not alone, but as an addition to metformin. This provides better blood sugar control. The drug Byeta-Long, which is produced by Astra Zeneca, has been used in Europe since 2011, and it appeared on the Russian market only 2 years ago, in 2017.
Despite the subcutaneous injection, the drug is in microspheres, which, once under the skin, are gradually absorbed, and the drug is gradually removed from the injection site. But, nevertheless, there is a risk of developing special antibodies to this drug, and according to the laws of the immune system, the less often the drug is injected, the higher the risk of such neutralizing antibodies, which reduce the entire clinical effect. In the event that the usual short-acting liraglutide is used once a day, then the risk of antibodies is much lower. How much does Byetta Long cost? In pharmacies in Moscow, you can purchase a pack of 4 pieces, designed for a month, for 11,000 rubles.
After reading about hormonal drugs, people with overweight, but without diabetes, will surely be saddened. How can they be? Very simple. If the doctor advises, then you can use, however, very carefully, strictly according to indications and in the absence of contraindications, drugs from the group of antidepressants. It has long been known that mood-enhancing drugs from the group of especially selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, paroxetine, and others, have a side effect of decreased appetite. For some, this effect is more pronounced, and for some it is less. One of the leaders in the severity of appetite suppression from antidepressants is the drug sibutramine.
Sibutramine (Meridia, Reduxin, Slimia, Goldline Plus)
Despite the fact that this drug acts directly on the main center of appetite regulation in the brain, it belongs to antidepressants and not anorectics. That is, its antidepressant effect is still considered to be the main one, since it blocks the reuptake of neurotransmitters.
Let's say right away that for 9 years it has been banned from using it in Europe, due to the high risk of cardiovascular complications. In the United States of America, it is approved for use, but with a mandatory reservation from the manufacturer in the instructions that if the patient has a cardiovascular disease, then it cannot be used. In our country, it is sold, although it cannot be bought on the free market, but only by prescription, and it is included in potent drugs. But if you wish, you can purchase it.
Some weight loss fanatics combine the use of sibutramine with the above-described metformin for the treatment of type 2 diabetes. This is a categorically contraindicated and harmful combination. Sibutramine has side effects associated with the risk of high blood pressure. Constipation, insomnia, irritability, headaches appear. A large number of even deaths are known, usually associated with self-medication and improper prescription of the drug.
Sibutramine can be included in various dietary supplements that are offered for weight loss, and the dosage in these supplements can be many times higher than the maximum allowable, but the fact of the presence of sibutramine can be hidden. Therefore, you need to be extremely choosy in the choice of weight loss drugs, especially those on the free sale, purchased on the Internet and brought from China.
One of the most purified drugs is Meridia, which is produced by Abbott and is sold in 15 mg capsules, 28 capsules in a package. It must be prescribed when the body mass index exceeds 27. The result can be considered a decrease in body weight by 10% after 6 months.
We will briefly list the main official contraindications for taking sibutramine:
- organic obesity, that is, when the cause is associated with any disease;
- the presence of appetite and eating disorders – exhaustion caused by anorexia or the presence of bulimia;
- psychical deviations;
- taking MAO inhibitors;
- cardiovascular disease or the presence of arterial hypertension;
- increased thyroid function;
- chronic kidney and liver failure;
- prostate adenoma, adrenal tumor, glaucoma;
- childhood, pregnancy and breastfeeding;
- chronic alcoholism and drug addiction.
Thus, not all obesity can be treated with sibutramine.
Russian preparations of sibutramine on the market – Reduxin and Goldline plus in their composition, in addition to sibutramine, have microcrystalline cellulose. It is not absorbed by the body, has no medicinal effect, but it swells and creates a false feeling of satiety, as does bran or ordinary fiber. Therefore, in the event that you really want to lose weight, but are rightly afraid of the side effects of sibutramine, then just eat regular bran. This is both useful and inexpensive, and, in the end, will lead to weight loss.
It should be added that even domestic and not the best sibutramine preparations in the world, such as Reduxin and Goldline plus, are not cheap means. The minimum cost of a package of Reduksin produced by the domestic company Ozone in the amount of 30 capsules will cost from 1400 rubles.
Of course, there are other drugs from the group of antidepressants, such as Prozac (fluoxetine), Velafax (venlafaxine) from the Croatian company Pliva, or Rexetine aka paroxetine from the Hungarian company Gedeon Richter. These are antidepressants that are used when indicated to treat anxiety and depression. Decreased appetite and weight loss will be a corresponding side effect. In the free sale, without a prescription, they cannot be bought and rightly so. However, even if these drugs are prescribed according to indications, then they have specific side reactions characteristic of the SSRI group. For example, dry mouth, restless legs syndrome at night, and ejaculatory disorders in men.
About prospects and foreign drugs
In countries with developed health care, there is ongoing testing and research of new drugs, as well as different combinations of old ones that can be used to treat obesity. For example, there is the drug Contrave. It is not registered in the Russian Federation and is not sold, but is used abroad. It is a combination of the opioid receptor blocker naltrexone and the serotonin reuptake inhibitor bupropion. As a result of the use of Contrave for the same long period of 56 weeks, volunteers lost about 5% of their body weight.
Rimonabat (Akomplia, Zimulti)
There is a promising trend in the use of cannabinoid receptor blockers that can be used as anorectics or as appetite suppressants. But for now, alas, the first pancake is lumpy. The drug Acomplia, or rimonabat, has already been created. It is a pure cannabinoid receptor antagonist and acted exclusively on the appetite center. Again, it was not devoid of side effects, the main of which was considered to be increased thermogenesis. In Russia, it was sold until 2010 under the name Zimulti, but then it was withdrawn, first in Europe and then in Russia, because it had even more serious side effects associated with neuropsychiatric disorders during admission.
Of the funds that are used abroad to reduce appetite, lorcaserin, or Belvik, is currently most often used. It is structurally a mild relative of amphetamines, and works best within a few months of use, with prolonged administration (a year or longer) its effectiveness decreases. It is known that patients with diabetes mellitus and obesity also lost about 5% of their body weight during the year of treatment. Lorcaserin is the only one of anorectics, that is, drugs that reduce appetite, which can be used for a long time and is not addictive.
There are other drugs such as Tenuate, Bontril, Regimex – these are real relatives of amphetamines. They can already cause real physical and mental dependence, especially in the case of long-term use. Therefore, even in the United States of America, the circulation of these drugs is strictly controlled.
Ximia (phentermine + topiramate)
There is a drug called Ksimia. It is a combination of the antiepileptic drug topiramate, which has also recently appeared on the market, with phentermine. In our country, this remedy is unlikely to ever be used, since phentermine is included in list 2 of the list of narcotic and psychotropic drugs and their precursors. Phentermine is a strong psychostimulant, an amphetamine-like substance that strongly suppresses appetite.
Why is it approved for use in some countries? Because, unlike amphetamines, it does not cause ephoria and therefore does not form mental dependence. It is used in the form of the drug Adipex, and there are long-acting forms of this drug in Australia and New Zealand. The combination of this substance with topiramate allows you to increase the inhibitory activity of gamma-aminobutyric acid, and thus ensure that there will still be no addiction.
For the same long period of 56 weeks, patients reduced their body weight to 10 kg, and so far this is an obvious record. But Ximia and its analogs also have side effects. So, in women, the concentration of estrogen in the blood plasma decreases, and if they use combined oral contraceptives, then they are no longer so effective, and the risk of bleeding increases. With prolonged use, the frequency of anxiety and depressive episodes increases significantly, therefore, a full medical examination is necessary before using this drug.
In conclusion, I would like to warn readers against self-treatment of obesity with drugs, and various unregistered dubious food supplements, over-the-counter drugs that can be easily purchased in online stores. It is dangerous to health. As shown by numerous clinical studies, 85% of patients, and in general, people with persistent thoughts about losing weight do not need to use drugs. They can independently, in a year or two, reduce their body weight to ideal using non-drug methods – diet, physical activity and lifestyle changes.
Attention! This rating is subjective and does not constitute an advertisement and does not serve as a purchase guide. Before buying, you need to consult with a specialist.