What
is Rimonabant?
Rimonabant
is an anorectic anti-obesity drug. Its main avenue of effect is reduction
in appetite.In Europe, it is indicated for use in conjunction with diet
and exercise for patients with a body mass index greater than 30 kg/m²,
or patients wih a BMI greater than 27 kg/m² with associated risk
factors, such as type 2 diabetes or dyslipidaemia. In the UK, it has
been available since the end of July 2006.
It is a
CB1 cannabinoid receptor antagonist. Rimonabant is the first selective
CB1 receptor blocker to be approved for use anywhere in the world. Belgian
researchers writing in the Lancet 2005 said people taking rimonabant
lost an average of 8.6 kilograms (18.9 pounds) in a year. They also
lost an average of 8.5 centimetres (over three inches) from their waists.
However, in May 2007, Canadian researchers reported also in the Lancet
that the long-term impact of the drugs was not clearly known with side
effects including increased blood pressure and pulse rate for sibutramine
and mood-related disorders for rimonabant reported.
Rimonabant
may also be found to be effective in assisting some smokers to quit
smoking. Sanofi-Aventis is currently conducting studies to determine
the possible value of rimonabant in smoking-cessation therapy.
How is Rimonabant used?
Rimonabant pills are taken as one tablet once a day, before breakfast.
The patients should also follow a reduced calorie diet and increase
their level of physical activity. The drug should not be used in patients
who have severe problems with their liver or their kidneys.
How
does Rimonabant work?
The active substance rimonabant, is a cannabinoid receptor antagonist.
It acts by blocking a specific type of receptor, the cannabinoid type
1 (CB1) receptors. These receptors are found in the nervous system,
and they are part of the system the body uses to control food intake.
The receptors are also found in adipocytes (fat tissue).
Does
Rimonabant slimming pills also aid smoking cessation?
Generic
Acomplia has been studied by the french company Sanofi-Aventis as an
aid to smoking cessation based on studies for up to one year in over
6,500 smokers motivated to quit smoking
What
is the risk associated with Rimonabant ?
During the studies, the most common side effects with Rimonabant (seen
in more than 1 patient in 10) were nausea (feeling sick) and infections
of the upper respiratory tract. For the full list of all side effects
reported with thie medicine, see the Package Leaflet. Rimonabant should
not be used on people who may be hypersensitive (allergic) to rimonabant
or any of the other ingredients, or in women who are breast feeding.
It must also not be used in patients with ongoing major depression or
who are being treated with antidepressants, since it can increase the
risk of depression, including thoughts about suicide in a small minority
of patients. Patients who experience symptoms of depression should speak
to their doctor and may need to stop treatment. Caution should be used
when taking Rimonabant with some medicines, such as ketoconazole or
itraconazole (anti-fungal medicines), ritonavir (used in HIV infection),
or telithromycin or clarithromycin (antibiotics).
Rimonabant
and Smoking
While millions of obese people are excited at rimonabant's potential
in helping them reduce their weight, some researchers believe this revolutionary
drug could have a major role to play in helping smokers quit smoking
even though regulators on the first go-round refused to approve it for
this use.
While the
EC System is associated with regulating the body's intake of food, it
also is involved in tobacco dependency. Chronic tobacco use over-stimulates
the EC system creating an imbalance. rimonabant, by blocking the CB1
receptor, helps restore balance to the EC system resulting in reduced
dependence on tobacco.
Rimonabant
has "roughly doubled the odds of quitting smoking," said Dr.
Robert Anthenelli, associate professor of psychiatry at the University
of Cincinnati College of Medicine in Ohio. "We also found remarkably
reduced postcessation weight gain: a 77% reduction versus placebo....
"These
dual effects on smoking cessation and reduced weight gain make rimonabant
a promising agent for treating tobacco dependence," Anthenelli
added.
Doctors
say that while the percentage of smokers who benefit from rimonabant
is considerably less than the very high number of obese and overweight
individuals who benefit, the result among smokers is still significant
and compares favorably with other smoking cessation products.
But while
the initial smoking-cessation trial seemed pomising, results from a
second trial were less encouraging and Sanofi was denied approval for
use of rimonabant as a smoking cessation aid by both the U.S. Food and
Drug Administration and the European Medicines Agency (EMEA).
The regulators
asked for an additional clinical trial of rimonabant as an aid to helping
break the smoking habit, and Sanofi has not yet indicated whether it
intends to proceed with such a trial.
Obesity
questions
Is obesity
in pregnancy linked to poor outcomes for the mother or baby?
Answer:
We found a number of trials in this area and have therefore limited
our response to a relative small number of the more recent trials.
A 2006
Australian paper examined the effect of obesity in an obstetric population
and this concluded:
“Overweight
and obesity are common in pregnant women. Increasing BMI is associated
with maternal and neonatal outcomes that may increase the costs of obstetric
care. To assist in planning health service delivery, we believe that
BMI should be routinely recorded on perinatal data collection sheets.”
A 2007
paper “Maternal obesity in early pregnancy and risk of spontaneous
and elective preterm deliveries: a retrospective cohort study.”
, concluded:
“Obese
nulliparous women are at increased risk of elective preterm deliveries.
This in turn leads to an increased risk of perinatal mortality and is
likely to lead to increased risks of long-term disability among surviving
offspring.”
Another
2007 paper examined obesity and stillbirth , concluding:
“Maternal
obesity is associated with an increased risk of stillbirth, although
the mechanisms to explain this association are not clear.”
The final
2007 paper we found reported:
What
investigations are recommended to rule out underlying causes of weight
gain?
Answer:
We could find no recommendations regarding investigations related to
unexplained weight gain.
The only
information we could find was via the website WrongDiagnosis has a section
on it’s website that lists 176 causes of weight gain , it also
has a section on workup and diagnosis [2] which seems pertinent to the
question. It should be noted that Wrong Diagnosis is not a source we
usually use and the information is unreferenced, so use with caution.
“High
maternal weight seems to increase the risk of neonatal mortality, especially
in infants born after preterm PROM. Inflammation or infection related
to obesity may be part of the causal pathway.”
In 2004
Bandolier reported on BMI and pre-eclampsia giving the following ‘Clinical
bottom line’:
“Risk
of pre-eclampsia generally doubles with each 5-7 kg/sq metre increase
in pre-pregnancy body mass index.”
However,
it should be noted that a recent paper reported:
“BMI
appears to be a fairly weak predictor for pre-eclampsia. Although BMI
is virtually free of cost, noninvasive, and ubiquitously available,
its usefulness as a stand-alone test for risk stratification must await
formal cost-utility analysis. The findings of this review may serve
as input for such analyses.”
