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Over-the-Counter Drug Works to Suppress Appetite
May 29, 2000 -- It's almost here, that strip-down moment of truth: bathing suit season.
The need to squeeze into beachwear will lead some to crash diets and others to the local pharmacy, where they can pick up a nonprescription diet aid. These products often contain phenylpropanolamine (PPA), an appetite suppressant that is also used as a decongestant. One obesity expert says PPA can work -- but there's a risk of serious side effects.
"Phenylpropanolamine can significantly increase blood pressure and heart rate in individuals, and there seems to be no way to predict who will have this response," says Denise Bruner, MD. "There have been a number of cases of people who have suffered strokes, heart attack, cerebral hemorrhage,and died because they had pre-existing conditions." Bruner is president of the American Society of Bariatric Physicians, whose members specialize in managing obesity and related diseases.
PPA, the only over-the-counter appetite suppressant approved by the FDA, limits the appetite because of its effects on the hypothalamus, a control center in the brain. It is found in the popular diet aids Dexatrim and Accutrim, among others. These medications are designed to be used along with exercise and a sensible diet, and Chattem Inc., which markets Dexatrim, notes in a statement that "PPA has been effectively used by millions of consumers for more than fifty years in a variety of over-the-counter products."
Still, before people opt for an appetite suppressant, Bruner says, they ought to at least have their blood pressure measured -- and they should never consider pills the mainstay of weight loss therapy. "Suppression of the appetite is a particular aspect of the management of obesity," she says. "However, the cornerstones of management are physical activity and a sensible food plan."
Fifteen years ago, Marian Mocchietto of New Britain, Conn., sought the Dexatrim cure for weight loss after seeing commercials that featured "stick-thin" women.
"The first two days my appetite was suppressed. But I also had feelings of stomach churning and my heart beating a little faster," Mocchietto says. "My appetite was suppressed for only two or three days. So I took two capsules. That worked for a day or two, and then I took three."
Mocchietto stopped there. But some people don't.
"I had a patient in my practice using three to 10 boxes of these a day," Bruner says. "Thank God she didn't have any adverse effects. But she became dependent and it took her four months to withdraw."
"There's a false sense of security people have," says Patrick McKinney, MD, medical director of the New Mexico Poison Center in Albuquerque. "Since these are not a prescription drug, they think they can play with the dosage guidelines." But, he adds, some who are sensitive to the drug can have serious side effects even when following the recommended dose. Exactly how many get into trouble is unknown, but McKinney believes overdoses of PPA are probably underreported.
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