Anorectic

Short description: Drug which reduces appetite

An anorectic or anorexic is a drug which reduces appetite, resulting in lower food consumption, leading to weight loss.[1] These substances work by affecting the central nervous system or certain neurotransmitters to create a feeling of fullness or reduce the desire to eat. The understanding of anorexiant effects is crucial in the development of interventions for weight management, eating disorders, and related health concerns. The anorexiant effect can be induced through diverse mechanisms, ranging from hormonal regulation to neural signaling. Ghrelin, leptin, and peptide YY are among the hormones involved in appetite control. Additionally, neurotransmitters such as serotonin and dopamine in the central nervous system contribute significantly to the regulation of food intake.

By contrast, an appetite stimulant is referred to as orexigenic.

The term is (from the Greek ἀν- (an-) = "without" and ὄρεξις (órexis) = "appetite"), and such drugs are also known as anorexigenic, anorexiant, or appetite suppressant.

## Contents

* 1 History
* 2 Public health concerns
* 2.1 Non-pharmacological alternatives
* 3 List of anorectics
* 4 See also
* 5 References
* 6 External links

## History

Used on a short-term basis clinically to treat obesity, some appetite suppressants are also available over-the-counter. Several appetite suppressants are based on a mix of natural ingredients, mostly using green tea as its basis, in combination with other plant extracts such as fucoxanthin, found naturally in seaweed. Drugs of this class are frequently stimulants of the phenethylamine family, related to amphetamine.[citation needed]

The German and Finnish[2] militaries issued amphetamines (Pervitin) to soldiers commonly during the Second World War.[3] Similarly, the UK military was supplied with more than 72 million Benzedrine tablets and the US military with an approximately equal amount for situations, in which fatigue was not deemed to be an acceptable option.[4] Following the war, large amphetamine surpluses were redirected for use on the black[5] and the civilian market. Indeed, amphetamine itself was sold commercially as an appetite suppressant until it was outlawed in most parts of the world in the late 1950s because of safety issues. Many amphetamines produce side effects, including addiction, tachycardia and hypertension,[6] making prolonged unsupervised use dangerous.

## Public health concerns

Epidemics of fatal pulmonary hypertension and heart valve damage associated with pharmaceutical anorectic agents have led to the withdrawal of products from the market. This was the case with aminorex in the 1960s, and again in the 1990s with fenfluramine (see: Fen-phen).[7] Likewise, association of the related appetite suppressant phenylpropanolamine with hemorrhagic stroke led the Food and Drug Administration (FDA) to request its withdrawal from the market in the United States in 2000, and similar concerns regarding ephedrine resulted in an FDA ban on its inclusion in dietary supplements in 2004. A Federal judge later overturned this ban in 2005 during a challenge by supplement maker Nutraceuticals. It is also debatable as to whether the ephedrine ban had more to do with its use as a precursor in methamphetamine manufacture rather than health concerns with the ingredient as such.[citation needed]

### Non-pharmacological alternatives

Weight loss effects of water have been subject to some scientific research as a potential non-pharmacological approach.[8] Drinking water prior to each meal may help in appetite suppression. Consumption of 500 mL (approximately 17 fl oz) of water 30 minutes before meals has been correlated with modest weight loss (1–2 kg; 2 to 4 lb) in obese men and women over a period of 8 to 12 weeks.[9][10]

## List of anorectics

Numerous pharmaceutical compounds are marketed as appetite suppressants.

The following drugs are listed as "centrally-acting antiobesity preparations" in the Anatomical Therapeutic Chemical Classification System:[11]

* Amfepramone (also known as diethylpropion)
* Bupropion and naltrexone (combination)
* Cathine
* Clobenzorex
* Dexfenfluramine† (the D-enantiomer of fenfluramine; withdrawn for the same reason as its racemate)
* Ephedrine (combinations)
* Etilamfetamine
* Fenfluramine† (one of the two components [the other being phentermine] of Fen-phen. Since discontinued to its potential for causing valvulopathies and pulmonary hypertension)
* Lorcaserin (withdrawn in the United States by the FDA due to an increased risk of cancer)[12]
* Mazindol
* Mefenorex
* Phentermine
* Sibutramine† (in some countries withdrawn from the market because of concerns regarding its cardiovascular effects)
* Topiramate

The following are listed as appetite depressants by MeSH, an index of medical journal articles and books.[13]

* Benfluorex (removed from the market by the EMA due to increased risk of heart disease)[14]
* Butenolide
* Diethylpropion
* FG-7142
* Phenmetrazine† (withdrawn in some countries due to the danger of addiction)
* Phentermine
* Phenylpropanolamine
* Pyroglutamyl-histidyl-glycine
* Sibutramine

Other compounds with known appetite suppressant activity include:

* Amphetamine-Dextroamphetamine is known to hamper appetite. Amphetamine-Dextroamphetamine is used to treat Attention deficit hyperactivity disorder (ADHD) and is usually under the trade name "Adderall" or "Mydayis".[15][16]
* Amphetamine sulfate (also known as amfetamine) – US FDA-approved for the treatment of exogenous obesity under the brand name "Evekeo".[17]
* Methylphenidate
* Cocaine[18]
* Caffeine[19]
* Glucomannan[20][21]
* Leptin[22]
* Methamphetamine hydrochloride – USFDA-approved for the treatment of obesity (as a short-term) under the brand name "Desoxyn".[23]
* Nicotine[24]
* Liraglutide as brand name Saxenda
* Semaglutide (brand name Ozempic/Wegovy) GLP-1 agonist
* Metformin
* Opiates/opioids such as heroin, morphine, codeine, oxycodone, fentanyl, etc.

## See also

* Anti-obesity medication

## References

1. ↑ Lemke, Thomas L.; Williams, David A., eds (2012). "Anorexiants as Pharmacologic Agents in the Management of Obesity". Foye's Medicinal Chemistry. pp. 1451–6. ISBN 978-1-60913-345-0.
2. ↑ :fi:Pervitiini
3. ↑ Ulrich, Andreas (May 6, 2005). "The Nazi Death Machine: Hitler's Drugged Soldiers". Spiegel Online. http://www.spiegel.de/international/0,1518,354606,00.html.
4. ↑ Bett, W. R. (1946-08-01). "Benzedrine Sulphate in Clinical Medicine" (in en). Postgraduate Medical Journal 22 (250): 215. doi:10.1136/pgmj.22.250.205. ISSN 0032-5473. PMID 20997404.
5. ↑ Heal, David J; Smith, Sharon L; Gosden, Jane; Nutt, David J (June 2013). "Amphetamine, past and present – a pharmacological and clinical perspective" (in en). Journal of Psychopharmacology 27 (6): 486. doi:10.1177/0269881113482532. ISSN 0269-8811. PMID 23539642.
6. ↑ Abenhaim, Lucien; Moride, Yola; Brenot, François; Rich, Stuart; Benichou, Jacques; Kurz, Xavier; Higenbottam, Tim; Oakley, Celia et al. (1996). "Appetite-Suppressant Drugs and the Risk of Primary Pulmonary Hypertension". New England Journal of Medicine 335 (9): 609–16. doi:10.1056/NEJM199608293350901. PMID 8692238.
7. ↑ Fishman, A. P. (1999). "Aminorex to Fen/Phen : An Epidemic Foretold". Circulation 99 (1): 156–61. doi:10.1161/01.cir.99.1.156. PMID 9884392.
8. ↑ Handbook of Non Drug Intervention (HANDI) Project Team (2013). "Pre-meal water consumption for weight loss". Australian Family Physician 42 (7): 478. PMID 23826600. http://www.racgp.org.au/afp/2013/july/pre-meal-water/.
9. ↑ Dennis, Elizabeth A.; Dengo, Ana Laura; Comber, Dana L.; Flack, Kyle D.; Savla, Jyoti; Davy, Kevin P.; Davy, Brenda M. (2009). "Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle-aged and Older Adults". Obesity 18 (2): 300–7. doi:10.1038/oby.2009.235. PMID 19661958.
10. ↑ Vij, Vinu Ashokkumar; Joshi, Anjalis (2014). "Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants". Journal of Natural Science, Biology and Medicine 5 (2): 340–4. doi:10.4103/0976-9668.136180. PMID 25097411.
11. ↑ ATC/DDD Index
12. ↑ Research, Center for Drug Evaluation and (2020-02-13). "FDA requests the withdrawal of the weight-loss drug Belviq, Belviq XR (lorcaserin) from the market" (in en). FDA. https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-withdrawal-weight-loss-drug-belviq-belviq-xr-lorcaserin-market.
13. ↑ MeSH list of agents 82001067
14. ↑ "European Medicines Agency recommends withdrawal of benfluorex from the market in European Union". December 12, 2009. https://www.ema.europa.eu/en/news/european-medicines-agency-recommends-withdrawal-benfluorex-market-european-union.
15. ↑ "Attention deficit hyperactivity disorder (ADHD) - Treatment" (in en). 2018-06-01. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/.
16. ↑ "Adderall Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD" (in en). https://www.webmd.com/drugs/2/drug-63163/adderall-oral/details.
17. ↑ "Evekeo Prescribing Information". Arbor Pharmaceuticals LLC. April 2014. pp. 1–2. https://www.evekeo.com/assets/evekeo-pi.pdf.
18. ↑ Wood, Douglas M; Emmett-Oglesby, Michael W (1988). "Substitution and cross-tolerance profiles of anorectic drugs in rats trained to detect the discriminative stimulus properties of cocaine". Psychopharmacology 95 (3): 364–8. doi:10.1007/BF00181948. PMID 3137623.
19. ↑ "The Face-Off: Coffee Vs. Tea" (in en-US). 2012-04-06. https://www.menshealth.com/nutrition/a19522222/the-face-off-coffee-vs-tea/.
20. ↑ Mohammadpour, Saba; Amini, Mohammad Reza; Shahinfar, Hossein; Tijani, Aliyu Jibril; Shahavandi, Mahshid; Ghorbaninejad, Parivash; Djafarian, Kurosh; Shab-Bidar, Sakineh (September 2020). "Effects of glucomannan supplementation on weight loss in overweight and obese adults: A systematic review and meta-analysis of randomized controlled trials". Obesity Medicine 19: 100276. doi:10.1016/j.obmed.2020.100276.
21. ↑ Guo, Liping; Yokoyama, Wallace; Chen, Maoshen; Zhong, Fang (November 2021). "Konjac glucomannan molecular and rheological properties that delay gastric emptying and improve the regulation of appetite". Food Hydrocolloids 120: 106894. doi:10.1016/j.foodhyd.2021.106894. ISSN 0268-005X.
22. ↑ Klok, M. D.; Jakobsdottir, S.; Drent, M. L. (January 2007). "The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review". Obesity Reviews 8 (1): 21–34. doi:10.1111/j.1467-789X.2006.00270.x. PMID 17212793.
23. ↑ "Desoxyn Prescribing Information". United States Food and Drug Administration. December 2013. http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/005378s028lbl.pdf.
24. ↑ "Why smoking makes you lose weight and no, it's not a good idea". The Times of India. ISSN 0971-8257. https://timesofindia.indiatimes.com/life-style/health-fitness/photo-stories/why-smoking-makes-you-lose-weight-and-no-its-not-a-good-idea/photostory/62756866.cms.

## External links

* Anorectics at the US National Library of Medicine Medical Subject Headings (MeSH)
* Mitchell, Kari (January 1997). "Anorexiant Agents: Considerations for Use". Drug Therapy Topics. University of Washington Medical Center. http://depts.washington.edu/druginfo/DTT/1997_Vol26_Files/V26N1.pdf.

* v
* t
* e

Antiobesity agents/Anorectics (A08)

Central|

| Stimulants|

* 4-Methylamphetamine‡
* Amfecloral
* Amfepentorex
* Amfepramone
* Aminorex‡
* Amphetamine
* Amphetaminil
* Atomoxetine
* Benfluorex‡
* Benzphetamine
* Bupropion (+naltrexone; +zonisamide†)
* Cathine
* Cathinone
* Chlorphentermine
* Ciclazindol
* Clobenzorex
* Cloforex
* Clominorex
* Clortermine
* Dexfenfluramine‡
* Dextroamphetamine
* Dexmethylphenidate
* Difemetorex‡
* Dimethylcathinone
* Ephedrine
* Ephedra‡
* Etilamfetamine
* Etolorex
* Fenbutrazate
* Fencamfamin
* Fenethylline
* Fenfluramine‡ (+phentermine‡)
* Fenproporex
* Fludorex
* Fluminorex
* Furfenorex‡
* Indanorex
* Khat
* Levopropylhexedrine
* Lisdexamfetamine
* Manifaxine
* Mazindol
* Mefenorex
* Methamphetamine
* Methylphenidate
* Norfenfluramine
* Pemoline
* Pentorex
* Phendimetrazine
* Phenethylamine
* Phenmetrazine
* Phentermine (+topiramate)
* Phenylpropanolamine
* Picilorex
* Pipradrol
* Prolintane
* Propylhexedrine
* Pseudoephedrine
* Pyrovalerone
* Radafaxine
* Reboxetine
* Setazindol
* Sibutramine‡
* Synephrine
* Tesofensine
* Viloxazine
* Xylopropamine
* Zylofuramine

|

Cannabinoid
receptor antagonists|

* Drinabant§
* Ibipinabant§
* Otenabant§
* Rimonabant‡
* Rosonabant§
* Surinabant§
* Taranabant§

Others|

* 5-HTP
* Beloranib§
* Galactomannan
* Guar gum
* Glucomannan
* L-DOPA
* L-Phenylalanine
* L-Tryptophan
* L-Tyrosine
* Lorcaserin
* Lu AA-33810
* Metformin
* Naltrexone
* Naloxone
* Oxyntomodulin
* P57
* Peptide YY
* Topiramate
* Velneperit§
* Yohimbine (Yohimbe)
* Zonisamide
* Water

Peripheral|

* Cetilistat
* 2,4-Dinitrophenol‡
* Dirlotapide
* Mitratapide
* Oleoyl-estrone
* Orlistat
* Simmondsin
* Sterculia

* #WHO-EM
* ‡Withdrawn from market
* Clinical trials:
* †Phase III
* §Never to phase III

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