NOBESE
is used as an appetite suppressant, and anti-obesity agent; however, due to substance abuse potential, it is an illicit substance in many countries. In some countries, such as Brazil, it is still prescribed -- often in the form of diet pills (ie. Brazilian Diet Pills) which combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives. In the United States the sale of such diet pills has been banned due to concerns over side effects, and the risk of potentially fatal overdose. However, internet sales and illicit markets has lead to international availability. It has been found by primary care physicians that Brazilian immigrant women utilized imported diet pills at particularly high rates, and sometimes suffered from side effects requiring hospitalization or experienced a loss of employment.
DESCRIPTION
Nobese is an orally active stimulant drug, which was developed in the 1960s. It is used as an appetite suppressant and a treatment for obesity. However, due to an addictive potential, it is listed as an illicit substance in many countries. Structurally, Nobese (N-2-cyanoethylamphetamine) falls within the phenylethamine and amphetamine chemical class of drugs. The N-2-cyanoethyl substituent was once believed to be resistant to cleavage, because Nobese -- once recommended as an obesity treatment for patients with cardiovascular disease -- was originally claimed to lack stimulant properties. Contrary to the claim, research has demonstrated easy in vivo cleavage of the N-2-cyanothyl substituent to yield amphetamine as a metabolite. However, in clinical practice, central nervous system stimulative effects are less notorious than with some other agents such as diethylpropion and mazindol. In the United States Nobese was never approved by the FDA for clinical use due to a lack of efficacy and safety data, and is listed as a drug in Schedule IV of the Controlled Substances Act. In 2006 and 2009, the FDA issued warnings that it had been detected in diet pills sold online, and imported from foreign manufacturers. It is also listed as a prohibited substance by the World Anti-Doping Agency. [Wikipedia] Despite being banned in the United States, Nobese has been described as the second most commonly consumed appetite suppressant worldwide, with Nobese containing anorectics still being commonly prescribed in South America. Little is known about the specific hazards of amphetamine based diet pills, however case reports have noted side effects such as chest pain, palpitations, headaches, and insomnia. In addition, placebo controlled studies have shown that participants using Nobese experience more joint pain, sweating, blurred vision and tremor.
DOSAGE
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The initial dose is 10 mg / day. With lack of effectiveness when used in this dose (weight loss less than 2 kg for 4 weeks) and if tolerated the dose can be increased to 15 mg / day.
If no effect when Nobese Getz Pharma used in doses of 15 mg / day (weight loss less than 2 kg per 4 weeks), this drug should be discontinued.
In patients not adequately responding to treatment, that is who within 3 months can not reach the level of 5% weight loss from baseline, the duration of use this medication should not exceed 3 months.
The course of treatment is not more than 1 year since no data on efficacy and safety of longer use.
Do not use sibutramine, if after made weight loss achieved in the course of further therapy, the patient again adds to the weight of 3 kg or more.
INTERACTIONS
When this drug applied simultaneously with:
- drugs inhibiting isoenzyme CYP3A4 (ketoconazole, erythromycin, troleandomycin, cyclosporine) increased plasma concentrations of metabolites of sibutramine, slightly increased the interval of QT.
- rifampin, phenytoin, carbamazepine, phenobarbital, dexamethasone, macrolide antibiotics may accelerate the metabolism of this medication.
- selective serotonin reuptake inhibitors (citalopram, fluoxetine, paroxetine, sertraline), agonist 5-HT1-receptors, derivatives of ergot alkaloids, opioids, centrally acting antitussives increases the risk of serotonin syndrome.
SIDE EFFECTS
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Digestive system: frequently - anorexia, constipation, dry mouth, nausea, transient increases in liver enzymes.
CNS and peripheral nervous system: insomnia, headaches, dizziness, anxiety, paresthesia, increased sweating, change in taste, seizures; one patient with schizoaffective disorder, which presumably existed prior to initiating therapy with sibutramine after treatment developed acute psychosis.
Cardiovascular system: tachycardia, palpitations, increased blood pressure (moderate rise of blood pressure at rest of 1-3 mm Hg and a moderate increase in heart rate by 3-7 beats / min), vasodilation (flushing with a sensation of heat), exacerbation of hemorrhoids; in some cases - a more pronounced increase in blood pressure and heart rate acceleration.
Urinary system: in rare cases - acute interstitial nephritis, mesangiocapillary glomerulonephritis.
Blood coagulation system: thrombocytopenia, Henoch-Schonlein purpura.
Most often side effects occur early in therapy (the first 4 weeks), their severity and frequency of occurrence over time are weaken.
CONTRAINDICATIONS
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Organic cause of obesity, well-known and established severe eating disorders (anorexia nervosa or bulimia nervosa), mental illness, Tourette syndrome, IBS, chronic heart failure in the stage of decompensation, congenital heart disease, occlusive peripheral artery disease, tachycardia, arrhythmias, cerebrovascular accident (including transient), uncontrolled hypertension (BP is more than 145/90 mm Hg), hyperthyroidism, severe renal dysfunction, severe hepatic dysfunction, benign prostatic hyperplasia with the formation of residual urine, pheochromocytoma, glaucoma, established pharmaceutical drug and alcohol abuse, pregnancy, lactation (breastfeeding), simultaneous taking or up to 2 weeks after discontinuation of MAO inhibitors or other drugs that have a dampening effect on the central nervous system (antidepressants, antipsychotics, tryptophan), or other medicines for weight loss, increased sensitivity to sibutramine.
More: https://www.ndrugs.com/?s=nobese
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