Prescription drugs, also referred to as ethical drugs, are drugs that are usually FDA-approved and that can only be purchased through the approval of a registered physician.

The different array of available FDA-approved prescription weight loss medications can generally be classified into two different groups based on their recommended duration of use – short- or long-term. This article will be looking at the different types of long-term prescription weight loss drugs that have been approved by the FDA.

Before proceeding, it is important to remember that these long-term prescription weight loss drugs are only recommended for individuals who are considered either overweight (with a BMI that is between 27 and 30 and that have obesity-related health conditions) or obese (with a BMI over 30 and that also have obesity-related health conditions). Some of the obesity-related conditions include heart disease, high blood pressure, high blood cholesterol, or diabetes that are generally detrimental to their lives.

Unlike the short-term FDA-approved prescription weight loss drugs that all happen to be appetite suppressants, the long-term prescription FDA-approved variants are made of two different types of drugs based on their generic names as well as their functions.

Sibutramine (Meridia or Reductil)

Sibutramine sold under the brand name Meridia in the United States and as Reductil in other countries was approved by the FDA in 1997 as a long-term weight loss medication for use up to two years for the treatment of obesity.

Sibutramine is an appetite suppressant like most of the other FDA-approved short-term weight loss drugs only that it has been approved for long-term use which might be responsible for its popularity.

Sibutramine works by inhibiting the reuptake of the catecholamines – norepinephrine, and dopamine, as well as serotonin. While norepinephrine and dopamine (a precursor of epinephrine, aka adrenaline) increase both blood pressure and the rate and depth of breathing, and decrease in the activities of the intestines, serotonin on the other hand, carries signals of satisfaction from nerve cells to the brain.

Reuptake is a process of chemical re-absorption by the body. During the process of reuptake, once neurotransmitters have been secreted into synapses (the gaps between nerve endings) and have passed on their chemical signals, the presynaptic neuron – being the nerve cell from which the signal was released – clears the synapse of the neurotransmitter molecules by reabsorbing same.

Sibutramine blocks the reuptake process thereby allowing the neurotransmitters to remain in the synapse for a longer period of time which consequently prolongs its ability to act as a signal. This leads to increased levels of the circulating amounts of these neurotransmitters in the body which then makes you to feel more energetic and satiated for longer periods of time even with lesser amount of food intake.

Additionally, Sibutramine also inhibits neuropeptide Y – a neurotransmitter which is believed to signal the body to eat, decrease physical activity levels, and increase fat storage.

Some studies have shown that 85% of obese patients taking sibutramine lost at least 5 percent of their body weight while at 57 percent lost an average of 10 percent of their body weight. However, safety and efficacy of sibutramine beyond two years have not been established.

However, sibutramine has been associated with some side effects which include but not limited to increased blood pressure, dry mouth, headache, constipation, and insomnia. Also people with a history of uncontrolled high blood pressure, congestive heart failure, heart disease, or stroke are strongly advised not to make use of sibutramine.

Orlistat (Xenical)

On the 26th of April 1999, the FDA approved the first non-appetite suppressing prescription weight loss medication known as Orlistat for long-term use. Orlistat, also known as tetrahydrolipstatin (THL), is a crystalline power that is whitish in color and is classified under the drug class called lipase inhibitors.

Orlistat, marketed under the brand name Xenical by Roche prevents the digestion and absorption of dietary fats into the bloodstream by inhibiting the pancreatic enzyme lipase. Orlistat reduces the production level of pancreatic lipase which is the enzyme that breakdowns fats within the intestines thereby stopping ingested dietary fat from being hydrolyzed into free fatty acids which are usually more readily absorbed into the bloodstream. Consequently, the undigested fat is excreted through bowel movements within feces.

Lipase inhibitors have been found to reduce the amount of absorbed dietary fat that goes into the human body by as much as 30%. Orlistat, itself, is only slightly absorbed into the body although most of it is taken into the gastrointestinal tract and subsequently excreted in the stool.

When combined with a nutritionally balanced, reduced-calorie diet, orlistat when taken for six months helped adults lose 12.4 to 13.4 pounds on average according to recent studies which corroborated those performed before sibutramine was approved by the FDA.

The known side effects associated with using orlistat have mostly been reported within the first year of use with most of the severity and number of problems diminishing over time as the body becomes accustomed to the drug. Most of these side effects however tend to be acute, especially following the consumption of fatty foods and include diarrhea, bloating, flatulence, and loose, fatty, or oily stools.

Additional side effects might include abdominal, rectal, or chest pain; nasal congestion and difficult breathing; fever and headaches; as well as runny nose, sneezing and sore throat. Preliminary medical claims indicate that orlistat may also increase the risk of breast and colon cancers – however further scientific research is necessary to validate these claims.

Furthermore, orlistat is known to inhibit the absorption of fat-soluble vitamins especially A, D, E, and K as well as beta carotene. Therefore users are advised to take multivitamin supplements at least once daily. Lastly, the long-term safety of orlistat use is not known.

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