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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 43 to 67 of 69. Go back in thread:
Posted by SLS on August 15, 2005, at 18:09:14
In reply to Re: Sibutramine » darkhorse, posted by KaraS on August 15, 2005, at 10:03:56
> Good to know. You're probably right - if it were such a great AD and well as weight loss drug, then it would probably be a lot more popular by now.
>
> K
Peter Mueller, MD (one of the discoverers of seasonal affective disorder) swears by sibutramine. I still have it on my list of things to try.
- Scott
Posted by KaraS on August 15, 2005, at 22:01:29
In reply to Re: Sibutramine, posted by SLS on August 15, 2005, at 18:09:14
> > Good to know. You're probably right - if it were such a great AD and well as weight loss drug, then it would probably be a lot more popular by now.
> >
> > K
>
>
> Peter Mueller, MD (one of the discoverers of seasonal affective disorder) swears by sibutramine. I still have it on my list of things to try.
>
>
> - Scott
Hi Scott,I knew if I changed the title of the post to "Sibutramine" that I'd get a response from you and get a different opinion. :-)
Actually after I posted my response I thought about it some more and realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
Kara
Posted by darkhorse on August 16, 2005, at 3:59:01
In reply to Re: Sibutramine » SLS, posted by KaraS on August 15, 2005, at 22:01:29
realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
>
> KaraHi Kara :
I tried Desipramine,Nortriptyline and Maprotiline (The most selective NE inhibitor),and non of them made me irritable.
Dark Horse.
Posted by darkhorse on August 16, 2005, at 4:14:44
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » darkhorse, posted by ed_uk on August 15, 2005, at 11:01:45
> Hi ED
> It's interesting that it didn't make you depressed or agressive like reboxetine - another NRI.There must be something odd about Reboxetine.I'm sure of it!
>
> >Nortriptyline is different.When I took the first few doses,I felt everything was more colourful (vision-wise)really!- Nefazodone did the same but with headeache and apathy........
>
> They both block 5-HT2 receptors, perhaps that could have something to do with it. Do you get the same 'colour' effect from other 5-HT2 antagonists, like amitripyline?No.Maybe the strong antihistaminic effect makes ones vision more foggy than colourful!
>
> >Venlafaxine> It's interesting how many babblers switched from Effexor to Cymbalta, expecting Cymbalta to cause less apathy....... and then it caused more!
Yes,it is true.Duloxetine made me a vegetable from the 1st dose!but not Efexor.
DH
Posted by darkhorse on August 16, 2005, at 4:17:26
In reply to Re: Sibutramine, posted by darkhorse on August 16, 2005, at 3:59:01
> realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
> >
> > Kara
>
> Hi Kara :
>
> I tried Desipramine,Nortriptyline and Maprotiline (The most selective NE inhibitor),and non of them made me irritable.
>All the best!
> Dark Horse.
>
>
Posted by ed_uk on August 16, 2005, at 5:52:37
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » ed_uk, posted by darkhorse on August 16, 2005, at 4:14:44
Hi DH!
>There must be something odd about Reboxetine. I'm sure of it!
I agree..... although Meri-Tuuli (on babble) is currently benefiting from it!
>Maybe the strong antihistaminic effect makes ones vision more foggy than colourful!
You could be right there!
Are you taking an AD at the moment? Or just bromazepam?
mfg!
~ed
Posted by KaraS on August 16, 2005, at 11:35:51
In reply to Re: Sibutramine, posted by darkhorse on August 16, 2005, at 3:59:01
> realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
> >
> > Kara
>
> Hi Kara :
>
> I tried Desipramine,Nortriptyline and Maprotiline (The most selective NE inhibitor),and non of them made me irritable.
>
> Dark Horse.
>
>
Hmmm, that's interesting. I don't know why you reacted that way then. It's still not enough data for me to think that sibutramine won't be good for others.k
Posted by darkhorse on August 17, 2005, at 2:33:52
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » darkhorse, posted by ed_uk on August 16, 2005, at 5:52:37
> Hi ED
> Are you taking an AD at the moment? Or just bromazepam?
Yes :
Bromazepam 6mg
Venlafaxine 25mg
Amisulpride 50mg
That was for the last couple of weeks,but I'm planing to have a drug holiday soon.DH
>
> mfg!
>
> ~ed
Posted by darkhorse on August 17, 2005, at 2:41:54
In reply to Re: Sibutramine » darkhorse, posted by KaraS on August 16, 2005, at 11:35:51
It's still not enough data for me to think that sibutramine won't be good for others.
>
> k
>
>Hi Kara :
I believe that any medication can benefit some people,it is just a matter of general tolerability and marketing.I mean,Prozac was so popular,maybe because of marketing but I'm sure because a lot of people tolerate it.On the other side Valium is not marketed anymore and there is bad vibe about it in the media,but still it is the most frequently used benzo world wide.
But when a new "novel" medication comes out and does not sell well or make an impact,I think here one must be cautious about its tolerability and effectiveness for most people.
Just my opinion.Dark Horse.
Posted by KaraS on August 17, 2005, at 3:55:07
In reply to Re: Sibutramine » KaraS, posted by darkhorse on August 17, 2005, at 2:41:54
> It's still not enough data for me to think that sibutramine won't be good for others.
> >
> > k
> >
> >
>
> Hi Kara :
>
> I believe that any medication can benefit some people,it is just a matter of general tolerability and marketing.I mean,Prozac was so popular,maybe because of marketing but I'm sure because a lot of people tolerate it.On the other side Valium is not marketed anymore and there is bad vibe about it in the media,but still it is the most frequently used benzo world wide.
> But when a new "novel" medication comes out and does not sell well or make an impact,I think here one must be cautious about its tolerability and effectiveness for most people.
> Just my opinion.
>
> Dark Horse.
Maybe you're right. That was my first reaction. OTOH, maybe it wasn't marketed right or maybe people are afraid to take prescription diet drugs after Fen-Phen. It hasn't been approved as an antidepressant so that cuts down on the depression market. It seems like there are several other factors that could be involved.k
Posted by ed_uk on August 17, 2005, at 4:29:10
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » ed_uk, posted by darkhorse on August 17, 2005, at 2:33:52
Hi DH!
Any side effects from amisulpride? I can't rememeber when you've tried any other doses apart from 50mg. 12.5mg, 25mg, 75mg etc.
Kind regards
~ed
Posted by ed_uk on August 17, 2005, at 4:33:50
In reply to Re: Sibutramine » KaraS, posted by darkhorse on August 17, 2005, at 2:41:54
Hi DH,
Sibutramine was tested as an AD but was found to be ineffective. I wonder why?
Also, I've always wondered whether sibutramine, like SSRIs, Effexor and Cymbalta, might actually cause weight *gain* in the long run - at least in some people. I've known people to put on LOADS of weight on SSRIs and SNRIs!
Kind regards
~Ed
Posted by darkhorse on August 17, 2005, at 5:34:39
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » darkhorse, posted by ed_uk on August 17, 2005, at 4:29:10
> Hi DH!
>
> Any side effects from amisulpride? I can't rememeber when you've tried any other doses apart from 50mg. 12.5mg, 25mg, 75mg etc.
>
> Kind regards
>
> ~edHi ED,
I tried 50+50 within 24 hours,and no effect but also I did not notice a difference in both doses!
Sulpiride and Amisulpride at low doses nesrly do not have any side effect.
Posted by SLS on August 17, 2005, at 8:09:09
In reply to Re: Sibutramine » darkhorse, posted by ed_uk on August 17, 2005, at 4:33:50
> Hi DH,
>
> Sibutramine was tested as an AD but was found to be ineffective. I wonder why?I know it was developed as an antidepressant, but I'm not sure why the company dropped this indication in favor of obesity. Have you found any negative studies on the Net? I thought I had seen some a long time ago on Medline, but I can't find them right now.
- Scott
>
> Also, I've always wondered whether sibutramine, like SSRIs, Effexor and Cymbalta, might actually cause weight *gain* in the long run - at least in some people. I've known people to put on LOADS of weight on SSRIs and SNRIs!
>
> Kind regards
>
> ~Ed
Posted by ed_uk on August 17, 2005, at 8:19:45
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » ed_uk, posted by darkhorse on August 17, 2005, at 5:34:39
Hi DH,
You mentioned than amisulpride only has a mood elevating effect for a few days. Does it continue to help your anxiety?
kind regards
~ed
Posted by ed_uk on August 17, 2005, at 8:28:20
In reply to Re: Sibutramine » ed_uk, posted by SLS on August 17, 2005, at 8:09:09
Hi Scott,
Lundbeck (the pharmaceutical company) has a webite: www.psychotropics.dk
It says.......
'Develoment as antidepressant discontinued due to lack of efficacy. Development is continued as an antiobesity product (phase III clinical trials completed in 1994).'
~Ed
Posted by KaraS on August 17, 2005, at 13:51:22
In reply to Re: Sibutramine » SLS, posted by ed_uk on August 17, 2005, at 8:28:20
> Hi Scott,
>
> Lundbeck (the pharmaceutical company) has a webite: www.psychotropics.dk
>
> It says.......
>
> 'Develoment as antidepressant discontinued due to lack of efficacy. Development is continued as an antiobesity product (phase III clinical trials completed in 1994).'
>
> ~Ed
Didn't the initial tests for Prozac and a lot of other ADs indicate a lack of efficacy as well? (But they didn't stop pushing for them as ADs. I wonder what the difference was.)k
Posted by ed_uk on August 17, 2005, at 14:21:03
In reply to Re: Sibutramine » ed_uk, posted by KaraS on August 17, 2005, at 13:51:22
Hi K,
>Didn't the initial tests for Prozac and a lot of other ADs indicate a lack of efficacy as well?
A lot of ADs (most?) have had negative trials.
>I wonder what the difference was.....
I wonder.... I bet we won't ever know.
Ed xx
Posted by darkhorse on August 18, 2005, at 2:40:49
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » darkhorse, posted by ed_uk on August 17, 2005, at 8:19:45
> Hi DH,
>
> You mentioned than amisulpride only has a mood elevating effect for a few days. Does it continue to help your anxiety?
>
> kind regards
>
> ~edYes,it certainly does.
Posted by darkhorse on August 18, 2005, at 3:06:24
In reply to Re: Sibutramine » darkhorse, posted by ed_uk on August 17, 2005, at 4:33:50
> Hi DH,
>
> Sibutramine was tested as an AD but was found to be ineffective. I wonder why?
>
> Also, I've always wondered whether sibutramine, like SSRIs, Effexor and Cymbalta, might actually cause weight *gain* in the long run - at least in some people. I've known people to put on LOADS of weight on SSRIs and SNRIs!
>
> Kind regards
>
> ~EdHi ED,
I do not believe that by just labeling a medication "SNRI", means that all under this title are identical.I think that each drug is unique,even if they are very chemically closely related (Mianserin/Mirtazapine-Sulpiride/Amisulprid).
In the case odf the SNRIs there is a clear difference in the potency of 5ht/ne/da uptake inhibition :
Venlafaxine is much stronger on 5ht,followed by Duloxetine which also has a more potency towards 5ht.
However both Milnacipran and Sibutramine are more NE poten, and "maybe" that is why they do not produce weight gain on the long run..etc.All the best!
DH
Posted by ed_uk on August 18, 2005, at 9:21:10
In reply to Re: Sibutramine » ed_uk, posted by darkhorse on August 18, 2005, at 3:06:24
Hi DH!
>I do not believe that by just labeling a medication "SNRI", means that all under this title are identical.....
I agree :-) .......but there are often a lot of important similarities.
Kind regards
~ed
Posted by SLS on August 18, 2005, at 16:52:40
In reply to Re: Sibutramine » darkhorse, posted by ed_uk on August 18, 2005, at 9:21:10
Sometimes, I think this Public Citizen group is a menace. They constantly call for the removal of good drugs without fully evaluating their risk versus benefit for the people who actually need them. They don't seem to be very inclined to offer statistical and phenomenological perspective on the occurance of adverse events, and how they compare to other important drugs that carry even greater risk.
I don't know. I have just seen their name attached to too many drug removal projects that I didn't find had merit.
- Scott
--------------------------------------------------
U.S. FDA Refuses to Pull Abbott Obesity Drug
WASHINGTON (Reuters) Aug 17 - The U.S. Food and Drug Administration rejected a consumer group's petition to withdraw Abbott Laboratories Inc.'s obesity drug Meridia (sibutramine) but said it would continue to watch for safety problems, according to documents released on Wednesday.Consumer advocacy group Public Citizen had twice called on the agency to pull the drug from the market, citing deaths from cardiovascular problems in people using the drug.
But the FDA concluded that "sibutramine's overall risk-benefit profile supports it remaining available as a prescription drug for the treatment of appropriately selected obese patients," wrote Steven Galson, head of the agency's drug division.
Galson added that the agency had worked with Abbott to educate doctors about appropriate patients and to change the drug's label, adding the need to monitor patients' blood pressure.
Meridia is an appetite suppressant approved in 72 countries to treat obese adults along with dieting, according to the FDA. It can cause side effects ranging from headaches and constipation to higher blood pressure and a faster heart rate.
Public Citizen's Health Research Group Director Sidney Wolfe said the 50 heart-related deaths reported since the drug's approval still warrant its removal. While Meridia use has dropped, "many people are still getting this dangerous but not very effective drug," said Wolfe, whose group petitioned for the ban in 2002 and again in 2003.
Abbott, in a statement, criticized Public Citizen's analysis and said Meridia had repeatedly been proven safe and effective.
Long term effects of the drug on obesity-related death is still unknown, according to the drug's label.
Meridia is one of five approved drugs that FDA veteran scientist David Graham said should be scrutinized when he spoke at a congressional hearing last year.
On Wednesday, Graham said the FDA and the company were "relying on statistics" to keep the drug on the market. While studies show Meridia can help patients lose some pounds, the loss is not enough to improve patients' health, he said.
"What's the health benefit of losing 15 pounds if you weigh 300 pounds? There is none," Graham said. Because of the side effects, he said a study he did three years ago showed most patients stayed on the drug for less than a month.
Posted by ed_uk on August 18, 2005, at 18:03:11
In reply to Re: Sibutramine, posted by SLS on August 18, 2005, at 16:52:40
Hi Scott,
In most cases, I don't like it when people petition for drugs to be taken off the market. I certainly don't think Effexor should be taken off the market, for example, but people (on babble) frequently say that they think it should be.
I do think that doctors need to be better educated about the side effects of drugs.
~ed
Posted by darkhorse on August 19, 2005, at 3:41:20
In reply to Re: Sibutramine, posted by SLS on August 18, 2005, at 16:52:40
Hello Scott (& anyone interested),
Sibutramine is the only ever medication that resulted in getting a real medical condition.
I developed powerful Tachycardia on it,and it developed into a serious ventricular arrythmia,and the cardio doc gave me heart medications for several months.Thankfuly this condition started to decrease.
Later I tried it again and Tachycardia started.I'm 100% sure Sibutramine is the cause.
I've taken 10's & 10's of Psyc. medications and non had those side effect.
I'm not anti-sibutramine or putting it down but I do not think that cases against Sibutramine (especially serious heart cases) are fake.
P.S. I have no history of heart disease or my family.
Best Regards,
Dark Horse.
Posted by SLS on August 19, 2005, at 8:17:44
In reply to Re: Sibutramine » SLS, posted by darkhorse on August 19, 2005, at 3:41:20
Hi DH.
> Hello Scott (& anyone interested),
>
> Sibutramine is the only ever medication that resulted in getting a real medical condition.
>
> I developed powerful Tachycardia on it,and it developed into a serious ventricular arrythmia,and the cardio doc gave me heart medications for several months.Thankfuly this condition started to decrease.
>
> Later I tried it again and Tachycardia started.I'm 100% sure Sibutramine is the cause.
>
> I've taken 10's & 10's of Psyc. medications and non had those side effect.
>
> I'm not anti-sibutramine or putting it down but I do not think that cases against Sibutramine (especially serious heart cases) are fake.
>
> P.S. I have no history of heart disease or my family.
>
> Best Regards,
> Dark Horse.
>
Wow.That's pretty bad news. Mild to moderate tachycardia by itself is to be expected whenever one uses various antidepressants, especially the tricyclics. These drugs can produce arrhythmias, though, which is why it is prudent to have ECGs performed occasionally. Still, you don't seem to see too many cases of heart-block or arrhythmias being reported on PB. Nonetheless, this risk seems to be acceptable.
Yours is a disturbing story. Maybe these folks have a valid complaint about sibutramine.
Again, though, I think it is essential to place into perspective the rate of occurance of adverse events of a drug compared to those of other drugs in the phamocopeia, the rate of adverse event versus the seriousness of the condition being treated, the availability of other drugs for the same condition, the abiity to screen and monitor for the adverse event, the rate of occurance of similar adverse events inherent in the condition, etc... So many factors are involved in evaluating the desireability of placing a drug in usage.
"Public Citizen's Health Research Group Director Sidney Wolfe said the 50 heart-related deaths reported since the drug's approval still warrant its removal"
Sibutramine was approved in 1997 - 8 years ago. 50 heart-related deaths is a pretty small number when it is taken into consideration the rate of cardiac events in obesity in general.
"On Wednesday, Graham said the FDA and the company were "relying on statistics" to keep the drug on the market."
LOL I guess statistics have no place in the appraisal of evidence.
- Scott
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Dr. Bob is Robert Hsiung, MD,
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