Vivero L E, Anderson P O, Clark R F
Department of Pharmacy, Drug Information, University of California at San Diego Medical Center, 92103-8925, USA.
J Emerg Med. 1998 Mar-Apr;16(2):197-205. doi: 10.1016/S0736-4679(97)00289-8.
In an effort to combat obesity, several medications have been developed. The nonamphetamine anorectics, such as phentermine, fenfluramine, and dexfenfluramine, have been recommended as first-line drug therapy for the treatment of obesity once diet and exercise alone have failed. Numerous studies have shown that these agents can promote weight loss when combined with diet restriction and exercise. Although fenfluramine and dexfenfluramine lack the abuse potential of amphetamine and its congeners, these agents are associated with drug interactions and adverse effects. Concomitant administration of fenfluramine or dexfenfluramine with medications that enhance serotonin levels (e.g., antidepressants, monoamine oxidase inhibitors, and migraine medications) can precipitate serotonin syndrome. Sudden discontinuation of fenfluramine or dexfenfluramine after prolonged administration can precipitate withdrawal depressive symptoms. Primary pulmonary hypertension, a potentially fatal disorder, has been reported to occur approximately 30 times more frequently in patients receiving anorectic agents for more than 3 months compared to the general population. More recently, the association of these popular anorectics with valvular heart disease has caused increased concerns about their use. The risks of primary pulmonary hypertension, valvular heart disease, and the occurrence of convulsions, coma, and death in overdose appear to be equally likely with dexfenfluramine and fenfluramine. In addition, many patients who lose weight while taking these anorectics rapidly regain it after the medication has been discontinued.
为了对抗肥胖，已研发出多种药物。非苯丙胺类食欲抑制剂，如苯丁胺、芬氟拉明和右芬氟拉明，在单纯饮食和运动减肥失败后，被推荐作为治疗肥胖的一线药物疗法。大量研究表明，这些药物与饮食限制和运动相结合时可促进体重减轻。尽管芬氟拉明和右芬氟拉明不像苯丙胺及其同类物那样有滥用潜力，但这些药物存在药物相互作用和不良反应。芬氟拉明或右芬氟拉明与增强血清素水平的药物（如抗抑郁药、单胺氧化酶抑制剂和偏头痛药物）同时使用，可能引发血清素综合征。长期服用芬氟拉明或右芬氟拉明后突然停药，可能引发戒断抑郁症状。据报道，与普通人群相比，接受食欲抑制剂治疗超过3个月的患者中，原发性肺动脉高压（一种潜在致命疾病）的发生率高出约30倍。最近，这些常用食欲抑制剂与心脏瓣膜病的关联引发了人们对其使用的更多担忧。右芬氟拉明和芬氟拉明导致原发性肺动脉高压、心脏瓣膜病以及过量用药时惊厥、昏迷和死亡的风险似乎相同。此外，许多服用这些食欲抑制剂时体重减轻的患者在停药后体重会迅速反弹。
