No more sibutramine - what now?

The writing has been on the wall for any weight loss medications containing the compound sibutramine since January of this year. On 21 January Lisa Richwine published a report on “EU Agency Urges Ban on Diet Drug” in Reuters Health. The drug in question was sibutramine, the active ingredient in products such as Reductil, Ectiva, Ciplatrim and Meridia. Recently Simply Slim, an over-the-counter (OTC) herbal slimming pill, was found to contain high levels of sibutramine. The product was withdrawn from the South African market and recently relaunched without sibutramine (Pretoria News, 2010).

The latest developments

Last Monday it was announced in the press that Abbott Laboratories, who manufacture Reductil and Ectiva, were voluntarily withdrawing these sibutramine-containing slimming drugs from the South African market after consultation with the Medicines Control Council (MCC). According to the report, Abbott have also withdrawn these slimming pills in the USA, Australia, and Taiwan. The use of sibutramine for slimming purposes is banned in Europe.

The article in the Pretoria News (2010) also pointed out that the MCC has said that it intends taking “appropriated action” against generic versions of sibutramine-containing drugs such as Ciplatrim. A weight loss programme combining Ciplatrim and Weigh-Less was launched at the beginning of September 2009 and many of Health24's users reported that they were using it with varying degrees of success. In view of the MCC statement, Cipla may also be asked to withdraw Ciplatrim in the near future.

Reasons for the withdrawal

The Reuters report published in January 2010, said that a study called SCOUT, which compared Meridia (sibutramine) against placebo (dummy treatment) in 10 000 patients, had found an increased risk for heart attacks or stroke in subjects receiving the active drug.

Preliminary data indicated that 11.4% of the subjects receiving sibutramine had died, or had a heart attack, a stroke or cardiac arrest compared to 10% for subjects who were given the placebo treatment (Richwine, 2010).

In reaction to these findings, the EU elected to ban all sibutramine-containing medications immediately. Other countries, including South Africa, first evaluated the results of the study to assess the risk posed to persons using sibutramine for slimming purposes. Abbott Laboratories who produce Reductil and Ectiva in South Africa have now voluntarily withdrawn these two slimming products in South Africa.

What now?

Sibutramine was used for weight loss because it acts as an appetite suppressant and also stimulates metabolism. Many healthy individuals did benefit from using sibutramine to assist them with weight loss and did not develop any negative side-effects.

Now slimmers in this country will have to lose weight without the aid of Reductil or Ectiva, and possibly also Ciplatrim. Needless to say, Health24 users are starting to panic and I receive frantic postings on the DietDoc Message Board from people who are totally stymied in their attempts to lose weight.

One by one even those slimming medications which were developed over many years under stringent scientific conditions and were subjected to extensive safety tests are now proving to be dangerous and possibly fatal to health.

This is indeed a problematic situation especially in a country like South Africa where the latest statistics show that up to 67% of adult women are obese, 61% of adults are overweight, obese, or morbidly obese and 17% of children under the age of 9 years are overweight (Joubert et al, 2007; Skade, 2010).

While many people do lose weight successfully with the aid of appropriate slimming diets and regular exercise, some individuals need assistance to curb their appetites and give them support to achieve their weight loss goals.

Some tips for desperate slimmers

a) What not to do

The first and most important fact to keep in mind is that you need to preserve your health and not expose yourself to the risk of developing heart attacks and strokes. In view of the worldwide concern about the safety of sibutramine-containing pharmaceutical products, I would advise Health24 users as follows:

    * If you are at present taking any slimming medication purchased in South Africa that contains sibutramine (i.e. Reductil, Ectiva or Ciplatrim), please contact the prescribing doctor or your pharmacist and discuss the risks associated with taking the remaining pills in your possession. If you experience any side-effects or have any doubts, stop taking these medications immediately. Rather safe, than sorry.
    * Do NOT order any pharmaceutical products that contain sibutramine over the Internet (i.e. product such as Reduxane and Zelium from Europe, and Meridia from the USA or other parts of the world).
    * Be aware of the fact that some OTC slimming products may be illegally laced with sibutramine. The Pretoria News article published last Monday warned that a product called Beauty Bitter Orange Slimming Capsules, which is reputedly “100 percent herbal”, was found to contain excessive amounts of sibutramine when tested by the FDA of America (Pretoria News, 2010).
    * Avoid using OTC slimming pills, capsules, potions, liquids, and patches because they could contain undisclosed high levels of sibutramine, or be a waste of money or cause other undesirable side-effects like addiction, dehydration or loss of normal bowel function.
    * Never give children or teenagers slimming pills of any kind as they may damage their metabolism and have serious side-effects.

b) What you can do

Use safer options for weight loss such as a balanced, energy-reduced low-fat, low-glycaemic index (GI) diet and regular exercise. It may take longer and you may need to exercise greater self-control, but this is one way of losing weight safely and sensibly.

If the 3 top Losers in the SA Biggest Loser show on etv in 2008, were able to lose between 45 and 62 kg in 12 weeks, you too can lose weight if you set your mind to it and stick to your diet and exercise regimen.

Anyone struggling to lose weight, should consider consulting a registered dietician to help you with a tailored slimming diet that meets your special needs. You may have insulin resistance which requires the use of a low-fat, low-GI diet to promote effective weight loss. Having the support of a dietician to explain the details of such a diet and to give you encouragement as you lose weight may make the difference between success and failure.

Visit the website of the Association for Dietetics in SA to find a dietician in your area. Consulting a dietician for a slimming diet is particularly valuable if you suffer from health problems such as heart disease, diabetes, kidney disease, or metabolic syndrome. The dietician will take your medical conditions and any medications you may be taking for these conditions into account when working out a slimming diet for you.

The use of a low-GI diet should also prevent cravings that often cause attempts at slimming to fail. If you do not have constant cravings for sweets and carbohydrates because you are eating low-fat, high-fibre and low-GI carbohydrates as part of your slimming diet, you won’t need all kinds of pills to see you through your weight loss journey.

The withdrawal of sibutramine-containing slimming pills is therefore not the end of the line for slimmers, because you do have other options which are safe and sensible.