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PubMed1997

[Tolerance and acceptability of dexfenfluramine in the long-term treatment of obesity in private practice. ESIM Group].

OBJECTIVE: The value of a one year prescription of dexfenfluramine (dF) was demonstrated by a large multicentric study performed in centres specialised in the treatment of obesity (Guy-Grand 1989). We tried to evaluate the safety and acceptability of this treatment prescribed in routine practice. METHOD: 27 internal physicians or general practitioners recruited 58 overweight patients who received 15 mg of dF twice a day in association with a balanced hypocaloric diet and were followed for one year with two-monthly visits, plus a visit after the first month of treatment. At each visit, the patients were weighed and completed a questionnaire concerning hunger sensations, appetite, preference for sweet foods and the number of meals per day. RESULTS: 32 of the 58 patients (55%) followed the proposed treatment for 12 months. The dietary survey showed a significant reduction until the sixth month, then a maintenance until the twelfth month for the number of meals per day, the urge to eat, as well as the desire for foods prohibited by the diet. The course of the desire to eat sweet foods was similar but non-significant as compliance with diet deteriorated regularly with time from the second month of treatment onwards. Drug consumption, evaluated by the doctor, was regular for 79% of patients after 6 months and for 77% of patients at the end of the study. Acceptability was considered to be good or very good for 92% of patients after 6 months and for 97% after 12 months. The mean weight loss for the 32 patients who complied with treatment for twelve months was 8.8 kg, close to 10% of their initial weight. DISCUSSION: The long-term addition of dF to a moderate low calorie diet was well tolerated and perceived as an aid by the majority of patients. The weight loss achieved by general practice management, as well as the proportion of patients who completed 12 months of treatment, was close to that observed by Guy-Grand and should encourage general practitioners to undertake the outpatient treatment of obesity.

Adult↗
PubMed1997

Dexfenfluramine modulates hepatic glycogen metabolism by a calcium-dependent pathway.

In this study, the mechanism of action of dexfenfluramine (DEXF) at the hepatic level was investigated. The drug is shown to bind to the alpha 1-adrenergic receptor and to increase intracellular calcium in isolated rat hepatocytes, thereby activating phosphorylase via a calcium-dependent mechanism. Moreover, phosphorylase activation by DEXF was inhibited by different agents that interfere with the alpha 1-adrenergic signalling system: prazosin, phorbol 12 alpha-myristate 13 beta-acetate (PMA), and DEXF itself. We also show that phosphorylase activation induced by catecholamines and analogues (epinephrine, phenylephrine), whose actions are mediated by a calcium-dependent mechanism, was counteracted by the drug in the submillimolar range (0.1-1 mM). The activation of glycogenolysis by the drug is accompanied by a stimulation of the glycolytic flux (54% increase in lactate plus pyruvate accumulation), consistent with an increase in fructose-2,6-bisphosphate (F-2,6-BP) levels (36%). These results indicate that the interaction of DEXF with the alpha 1-adrenergic receptor channels glucose 6-phosphate derived from glycogen away from glucose production into the glycolytic pathway.

Adrenergic Agonists↗
PubMed1998

Acute effects of dexfenfluramine (d-FEN) and methylenedioxymethamphetamine (MDMA) before and after short-course, high-dose treatment.

The acute behavioral effects of methylenedioxymethamphetamine (MDMA) and dexfenfluramine (d-FEN) were assessed in six rhesus monkeys using performance in the National Center for Toxicological Research (NCTR) Operant Test Battery (OTB); three additional animals served as controls for neurochemical endpoints. The OTB consists of five food-reinforced tasks designed to model aspects of learning, short-term memory and attention, time estimation, motivation, and color and position discrimination. Shortly after the acute effects of each drug were determined, three of the monkeys received a short-course, high-dose exposure (2x /day x 4 days, intramuscular (i.m.) injections) of MDMA (10 mg/kg), while three monkeys were exposed to an identical regimen of d-FEN (5 mg/kg). Approximately one month later, the acute effects of each drug were again determined. In monkeys exposed to high-dose d-FEN, the sensitivities of the OTB tasks to acute disruption by either MDMA or d-FEN were essentially unchanged. Conversely, monkeys treated with high-dose MDMA were less sensitive to the acute behavioral effects of both drugs, although such an effect was seen more frequently for d-FEN and was OTB task specific. Thus a residual behavioral tolerance to the acute behavioral effects of MDMA and d-FEN was noted after high-dose MDMA exposure, but not after high-dose d-FEN exposure. These findings are surprising, as similar neurochemical effects (i.e., significant decreases of ca. 50% in serotonin in frontal cortex and hippocampus) were observed in all monkeys approximately six months after short-course, high-dose MDMA or d-FEN treatment.

Animals↗
PubMed1998

Adverse neuropsychiatric events associated with dexfenfluramine and fenfluramine.

1. There is a large body of evidence indicating that fenfluramines damage brain serotonin neurons in animals. 2. Little is known about potential adverse neuropsychiatric consequences in humans associated with use of fenfluramines that could potentially be related to serotonergic dysfunction. 3. The authors now report numerous cases of severe and, sometimes persistent, neuropsychiatric syndromes associated with fenfluramine use. 4. Thirty one representative cases are presented and summarized in table form. 5. Several of the cases presented suggest long-lasting deleterious effects of fenfluramines on brain serotonin function. 6. Clinicians should be vigilant for disorders of mood, anxiety, cognitive function and impulse control in patients previously exposed to fenfluramines.

Adolescent↗
PubMed1995

Clinical studies with dexfenfluramine: from past to future.

d Fenfluramine (dF) (15 mg twice daily) has been studied in controlled trials in human obesity. It has been shown to increase adherence to weight lowering programs, to double the number of patients losing 10 kg or more when compared with a fairly efficient placebo plus dietary counselling, and to prevent weight regain when continued over a 1 year period. Weight loss after 1 month and 4 months is likely to predict subsequent outcome. Also, significant improvement in metabolic risk factors and blood pressure were clearly demonstrated, even more markedly in some obesity-associated diseases, when body weight is maintained at a lower level. Even moderate but sustained weight loss of some 10% of starting weight or less has been confirmed to be of medical value. Tolerance and safety of dF can be considered acceptable, even if longer term follow-up is clearly needed. These studies support the concept that long-term pharmacotherapy with this serotoninergic drug might help achieve better outcome in the management of many obese patients, particularly in preventing relapse. The long-term managerial strategies to be developed for each patient might thus include dF together with dietary advice, behavioral modification and physical exercise, either simultaneously or sequentially.

Appetite Depressants↗