32.2 Anorexiants

Anorexiants are appetite suppressants that help manage weight by reducing hunger and increasing fullness. These medications work through various mechanisms, targeting the central nervous system to promote weight loss alongside lifestyle changes.

When combined with a healthy diet and exercise, anorexiants can lead to significant weight loss and improve obesity-related conditions. However, they come with potential side effects and interactions, requiring careful patient selection, monitoring, and education for safe and effective use.

Anorexiants in Weight Management

Key features and mechanisms of action

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Top images from around the web for Key features and mechanisms of action

• 

  Frontiers | The L-Cell in Nutritional Sensing and the Regulation of Appetite | Nutrition View original

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• 

  Frontiers | The Role of Norepinephrine and Its α-Adrenergic Receptors in the Pathophysiology and ... View original

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  Frontiers | The role of the serotonin receptor subtypes 5-HT1A and 5-HT7 and its interaction in ... View original

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  Frontiers | The L-Cell in Nutritional Sensing and the Regulation of Appetite | Nutrition View original

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• Anorexiants (appetite suppressants) reduce appetite and promote weight loss
  • Decrease hunger and increase fullness by acting on the central nervous system
• Mechanisms vary by drug
  • Phentermine (Adipex-P, Lomaira)
    • Releases norepinephrine, reducing appetite
    • Increases energy expenditure and fat breakdown (lipolysis)
  • Lorcaserin (Belviq)
    • Activates serotonin 2C receptors in the hypothalamus
    • Increases satiety and decreases food intake
  • Naltrexone/Bupropion (Contrave)
    • Opioid antagonist (naltrexone) and antidepressant (bupropion) combination
    • Naltrexone blocks opioid receptors, reducing eating reward
    • Bupropion increases dopamine and norepinephrine, suppressing appetite and increasing energy expenditure

Therapeutic benefits, side effects, and interactions

• Benefits
  • Promote weight loss with reduced-calorie diet and increased physical activity
  • May improve obesity-related conditions (hypertension, dyslipidemia, type 2 diabetes)
• Side effects
  • Phentermine: dry mouth, insomnia, constipation, irritability, increased heart rate and blood pressure
  • Lorcaserin: headache, dizziness, fatigue, nausea, constipation
  • Naltrexone/Bupropion: nausea, constipation, headache, vomiting, dizziness
• Interactions
  • Phentermine
    • MAOIs: hypertensive crisis risk
    • Serotonergic drugs: serotonin syndrome potential
  • Lorcaserin
    • Serotonergic drugs: increased serotonin syndrome risk
    • CYP2D6 inhibitors: may increase lorcaserin levels
  • Naltrexone/Bupropion
    • MAOIs: contraindicated due to hypertensive reaction risk
    • CYP2B6 inducers: may decrease bupropion levels

Nursing considerations

• Assessment
  • Obtain medical history (psychiatric, substance abuse)
  • Measure baseline weight, BMI, vitals, labs (lipids, glucose)
• Patient selection
  • Ensure criteria met (BMI ≥30 or ≥27 with comorbidities)
  • Consider contraindications (pregnancy, glaucoma, cardiovascular disease history)
• Monitoring
  • Regularly assess weight, BMI, vitals, adverse effects
  • Monitor for abuse or dependence signs, especially with phentermine
• Patient education
  • Emphasize combining medication with lifestyle changes
  • Instruct on administration, side effects, when to seek medical attention

Patient education plan

• Provide clear instructions on dosage, administration, treatment duration
• Emphasize reduced-calorie diet and regular physical activity importance
• Discuss realistic weight loss expectations (5-10% of initial weight)
• Advise reporting adverse effects or concerns to healthcare provider
• Encourage regular follow-ups to monitor progress and adjust treatment
• Stress not sharing medications, proper storage and disposal
• Educate on signs and symptoms of complications (serotonin syndrome, hypertensive crisis)
• Remind anorexiants are not long-term solutions, lifestyle changes crucial for maintaining weight loss