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1 : ,.,,. (body mass index, BMI) 30 BMI 27 BMI 25 BMI 23 1 )., (afferent signal),, (efferent signal). 2 )., ,. 3 ). T able

2 Young Duk Song : Drug treatment of obesity 1. 1) ) (5- hydroxytryptamine, 5- HT ). 5- HT 1B/ 1D 5- HT 2C. D-. (Prozac) (Seroxat) (selective serotonin reuptake inhibitors, SSRI). 3) Sibutramine (Reductil, Meridia) norepinephrine serotonine (SNRI: serotonin norepinephrine reuptake inhibitor). 2.,.. (1) Disaccharidase ;, (2) ; Orlistat 3. Ephedrine Caffeine. Caffeine adenosine receptor phosphodiesterase ephedrine. fat burner. uncoupling protein. 1. S ibutramine (Meridia, Reductil ) 1) Sibutramine 2 4, 5 ). Sibutramine serotonin (5-hydroxytryptamine; 5- HT ) and noradrenaline reuptake inhibitor (SNRI). Sibutramine secondary amine primary amine, NA reuptake selective NA reuptake inhibitor desipramine, serotonin reuptake selective serotonin reuptake inhibitor fluoxetine. Sibtramine monoamine neurotransmitter release monoamine oxidase (MAO).. 2) Sibutramine. D- amphetamine locomotor activity. NA reuptake inhibitor nisoxetine 5-HT reuptake inhibitor fluoxetine

3 : ) Sibutramine thermogenesis. sibutramine 30% 6, efferent sympathetic activity 3 - adrenoreceptor (AR). 3 - adrenoreceptor BRL sibutramine glucose utilization, BRL , sibutramine 18, BRL brown adipose tissue (BAT ) 3AR sibutramine BAT 3AR 1AR., sibutramine. 4) BMI kg/ m 2 sibtramine 10 mg 15 mg kg 1 6 ) kg, 10 mg, 15 mg 4.8 kg 6.1 kg. 1 5% 29%, 10 mg 56%, 15 mg 65%. 10% 8%, 10 mg 30%, 15 mg 39%. Sibutramine T rial of Obesity Reduction and Maintenance (ST ORM T rial) ). sibutramine 10 mg kg, 5.5 cm, CT 18%, 17%, 22%. 5) Sibutramine noradrenergic. Sibutramine mg 2 mmhg ,, LDL-, HDL-, type 2. 6) mg 1. sibutramine 8 sibutramine 8 ). sibutramine 1 1%. T able 2. S ibutramine % of patients Adverse events Sibutramine (1976) Placebo (605) Dry mouth 18 5 Dysmenorrhea 4 1 Anorexia 14 4 Sweating 3 < 1 Constipation 11 6 T achycardia 3 < 1 Insomnia 11 5 Vasodilation 3 < 1 Appetite increase 9 3 Ear disorder 2 < 1 Dizziness 7 4 Paresthesia 2 < 1 Nausea 6 3 Joint disorder 1 < 1 Abdominal pain 5 3 T enosynovitis 1 <

4 : 7) Sibutramine 84%, 71%, 18%, 14%, 11%, 11%, 9%, 7%, 6%, %. Serotonergic agents fenfluramine dexfenfluramine ( 2). 2. Orlistat (tetrahydrolipstatin, Xenical) 1) Orlistat Streptomyces toxytricini lipstatin. Orlistat - lactone ring lipase. Pancreatic lipase triglyceride free fatty acid monoglyceride 7 ). Orlistat triglyceride GI lipase serine lipase. 30%, 200 Kcal. Orlistat lipase,,. Lipoprotein lipase hepatic lipase GI lipase. 2) Orlistat BMI kg/ m 2 4, % mg 3 6.1% (6.1 kg) 10.2% (10.3 kg), 2 4.5% 8.1% 8 ). 1 5% 57.4% 77.2%, 10% 20 25% 35 50%. 1 52%, 26%. 2 1% 3% 5% cm 7.3 cm. 3) 1 orlistat LDL- LDL/ HDL,. Apo B Lp (a),.,, HbAlc type 2 9 ). 4) Orlistat 120 mg 3, mg 120 mg, 120 mg. Orlistat lipase, lipase orlistat. 5) Orlistat 97% %, 29.1%, %, 18.6%,

5 Korean Journal of Medicine : Vol. 62, No. 3, 2002 T able 3. Orlis tat Year 1 (1913) Year 2 (613) Adverse events Incidence (%) Withdrawal (%) Incidence (%) Withdrawal (%) Oily spotting Flatus with discharge Fecal urgency Fatty/ oily stool Oily evacuation Increased defecation Fecal incontinence T able 4. - Cholecystokinin (CCK) CCK inhibitor anagonist (butabindi) Gastrin-releasing peptide, neuromedin B, bombesin Glucagon- like peptide- 1 (GLP - 1) (pyruvate, lactate, 3- hydroxy- butylate, hydroxycitrate) - Melanocortin (MSH) - 4 (MC- 4) : MCH, galanin, CRH, orexin Serotonin (5- HT 2c) agonist Dopamine F atty acid transporer (FAT P4) 3- adrenergic receptor agonist Uncoupling protein (UCP - 1,2,3) Protein tyrosine phosphatase- 1B (PT P - 1B) Acyl CoA:diacyglycerol transferase (DGAT ) T estosterone 4.9%, 8.8%, 2 2.5%, 3.6%, 1 2.6%, 1.0%, 2 2.1%, 1.0% 1 0 ).,,, % 2 2 5% ( 3).. Orlistat -. orlistat,,,,,

6 Young Duk Song : Drug treatment of obesity pravastatin bioavailability. 3. Ephedrine/Caffeine. 10% 1 1 ).. Astrup 1 4 ) (60 mg/ 1 ) 6 10 kg, (600 mg/ 1 ) 10kg. ( 60 mg 600 mg/ 1 ) 15 kg % 60 75%... ( 4).. R E F E R E N C E S 1) ) Jequier E, T appy L. R egulation of body weight in humans. Physiol R ev 79: ) Bray GA, Greenway FL. A review of current and p otential drugs f or treatment of obesity. Endocr R ev 20: , ) Rolls BJ, Shide CJ, Thorwart ML, Ulbrecht JS. Sibutramine reduces food intake in nondieting women with obesity. Obes R es 6:1-11, ) Hansen DL et al. Thermogenic eff ects of sibutramine in humans. A m J Clin N atr 68: ) Seagle HM, Gessesen DH, Hill JO. Effects of sibutram ine on resting metabolic rate and weight loss in overweight women. Obes R es 6: , ) Sjostrom L, et al. Randomiz ed p lacebo- controlled trial of orlistat f or weight loss and p revention of weight regain in obese patients. E urop ean M ulticentre Orlistat Study Group. Lancet 352: , ) Davidson MH, Hauptman J, DiGirolamo M. Weight control and risk factor reduction in obese subj ects treated f or 2 years with orlistat. A random iz ed controlled trial. J A m M ed A ssoc 281: , ) Hollander P, et al. R ole of orlistat in the treatment of obese patients with typ e 2 diabetes. Diabetes Care 21: , ) Hill JO, et al. Orlistat, a lipase inhibitor, f or weight maintenance after conventional dieting A 1 year study. A m J Clin N utr 9: , ) Astrup A, Lundsgaard C. Enhanced thermogenic resp onsiveness during chronic ephedrine treatment in man. A m J Clin N utr 42:83-94, : : : : : COPD : B

Learning Objectives. Currently Available Options. Update on Weight Loss Pharmacotherapy. Dan Bessesen, MD

Learning Objectives. Currently Available Options. Update on Weight Loss Pharmacotherapy. Dan Bessesen, MD Update on Weight Loss Pharmacotherapy Dan Bessesen, MD Daniel.bessesen@ucdenver.edu Learning Objectives List the medications that are currently available for the treatment of obesity, describe their mechanisms