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Why Aren't Rx Weight-Loss Drugs More in Demand?

Loss of Appetite, Pounds continued...

After 3 months back on Qsymia, the 5-foot-5-inch Bell says she had dropped nearly 20 pounds from her starting weight of 214. (This may not represent typical weight loss on the drug.)

“It suppresses your appetite,” she says. “Stuff that I normally eat, I no longer have the desire to eat.” Or, she says, she’ll eat a much smaller portion. On top of that, she’s taken up running again, a pastime she had given up after moving from California to Boston 2 years ago.

Despite her initial success, she quit taking Qsymia in June.

“It was making me very irritable and angry,” says Bell, who works as a nurse’s aide and is enrolled in nursing school. “I’m not really an arguing type of person. It really did change my mood.” And she wasn’t sleeping as well as she used to, she says. “If I went to sleep, I couldn’t stay asleep. I couldn’t fall back asleep right away.”

She recently switched to phentermine. “It gives me a lot of energy, and it suppresses my appetite.” The main side effect, she says, is “cotton mouth,” but she deals with that by drinking a lot of water.

Side Effects

Vicki March, MD, an internist and obesity specialist at the University of Pittsburgh Medical Center, says, “I’m pretty cautious and mindful about whom I start on these medications.”

Insurance is a factor, she says, and people also worry the drugs won’t work or are concerned about side effects.

According to the FDA, Qsymia’s most common side effects are tingling of the hands and feet, dizziness, altered taste, insomnia, constipation, and dry mouth. The most common side effects of Belviq in people who don’t have diabetes are headache, dizziness, fatigue, nausea, dry mouth, and constipation, according to the FDA.  Also, people with heart failure need to be cautious taking this drug. Other side effects may include heart valve problems and a dangerous but rare condition called serotonin syndrome, in which high levels of the chemical serotonin build up in the body, causing symptoms including fever and seizures.

In people with diabetes, the most common side effects are low blood sugar, headache, back pain, cough, and fatigue.

Neither drug is supposed to be taken by pregnant women because of the risk of birth defects. Qsymia carries a risk of cleft palate or cleft lip; the drug’s safety information says women should have a pregnancy test to confirm they're not pregnant before beginning Qsymia and every month while taking it. The FDA has asked the makers of both drugs to do more studies to see whether they raise the risk of major problems such as heart attack and stroke.

March says she’s prescribed all three drugs with “great” results. For many obese people, she says, the potential side effects are worth the boost they give to weight-loss efforts. Still, losing weight isn’t as simple as popping a pill, she says. Anti-obesity medication “is not going to work by itself. It really isn’t.”


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