(1) Timing of medication. Appetite inhibitors can be used for adult obese people and selected adolescent obese people. These drugs can be used when dietary restrictions, exercise and behavioral therapy are still ineffective. Appetite inhibitors can reduce hunger and lose weight quickly.
In the comprehensive treatment, if the appetite suppressant with adjusted dose or maximum tolerance has been used for 3 ~ 4 weeks and the weight has not been reduced, the drug treatment should be stopped; If you continue to lose weight, you can continue to use it for a while.
(2) Duration of medication. Some people argue that appetite suppressants can only be used for a short time when the diet control effect is not good, but others think that appetite suppressants can be used for a long time to maintain the weight loss effect and prevent weight gain. The combination of appetite suppressants with different mechanisms of action can increase the curative effect. For example, a small dose of phentermine combined with fenfluramine can reduce the occurrence of tolerance, enhance the curative effect and reduce adverse reactions, and can be used continuously for about half a year. Fenfluramine can still maintain the curative effect after taking 1 year. However, long-term application of moindole will lead to hyperinsulinemia, and the long-term treatment effect will be reduced. How long the long-term treatment of appetite suppressants should last is still inconclusive. Most patients achieve the goal of losing weight within 12 ~ 24 weeks, and then they can take medicine intermittently when necessary (such as when there is enough food on holidays) to maintain the curative effect. Timely medication can reduce the weight fluctuation during obesity treatment, and whether the weight loss effect can be maintained after stopping medication depends on other comprehensive factors.
(3) combined medication. Most effective diet pills have different degrees of adverse reactions, especially when used in large doses. The combined application of drugs with different mechanisms of action can enhance the efficacy of weight loss, reduce the dosage of drugs and reduce the incidence of adverse reactions.
For example, the combination of fenfluramine and phenylbutylamine, an appetite suppressant, can enhance the 5- hydroxytryptamine system, while the latter can enhance the appetite suppression produced by catecholamine because of their different mechanisms of feeding behavior. When the two drugs are used together, the dosage of each drug is reduced, but the appetite suppression effect is enhanced, and the weight loss effect is no less than either of them, and the adverse reactions are reduced. Long-term use of moindole can lead to hyperinsulinemia, so the curative effect of long-term use is reduced. If insulin sensitizers such as rosiglitazone and metformin are used together, the adverse reactions of moindole can be corrected and the curative effect can be enhanced. The combination of ephedrine and caffeine can block adenosine A 1 receptor in presynaptic membrane, thus blocking the inhibitory effect of endogenous norepinephrine release, so it can enhance the appetite suppression effect of ephedrine and enhance the lipolysis effect, so the combination can significantly reduce the weight of obese patients. The combination of traditional Chinese medicine diet pills and low-dose appetite suppressants such as Dahuang tablets and fenfluramine can reduce the incidence of adverse reactions and achieve good weight loss effect.
(4) medication for special people. Teenagers are in the stage of growth and development, so weight-loss treatment must be strictly screened before medication, and strict medication monitoring must be carried out.
Studies have shown that fenfluramine, moindor, growth hormone and low-dose thyroid hormone generally do not affect the growth and development of obese children. It is forbidden to use appetite suppressants during pregnancy and lactation, and other weight-loss drugs are not recommended, because they may affect the development of the fetus and the growth of young children.
(5) Adverse reactions and drug selection. Most appetite suppressants and diet pills that increase energy consumption can produce different degrees of central nervous system excitement, which is manifested as irritable symptoms, insomnia, euphoria and so on. Susceptible people and long-term drug addicts may become dependent and lead to abuse. Addicts will have withdrawal symptoms when they suddenly stop taking drugs, especially amphetamine, so amphetamine and its compound preparations have been banned from being used for weight loss. Other amphetamine appetite suppressants, such as methamphetamine and methamphetamine, are also prone to dependence and should only be used as second-line drugs to lose weight. Fenfluramine mainly acts on serotonin, not catecholamine, so the main adverse reaction is sedation, which can cause depression and high dose can cause excitement. Long-term withdrawal can cause severe depression, so this product can not be given intermittently. Appetite suppressants, central stimulants and thyroxine, which increase energy consumption, can cause dry mouth, dilated pupils, blurred vision, dizziness, tachycardia, elevated blood pressure, arrhythmia and sweating by exciting the sympathetic nervous system, so they are not suitable for patients with hypertension, angina pectoris and hyperthyroidism. The incidence of these adverse reactions is low when using moindole and fenfluramine in conventional doses. Generally speaking, patients who lose weight after using the above-mentioned diet pills may be accompanied by a drop in blood pressure, while those who are susceptible will have an increase in blood pressure and tachycardia.
There are many gastrointestinal reactions such as lipase inhibitors and glucosidase inhibitors, and the former can also affect the absorption of fat-soluble vitamins, so long-term application should be cautious.
(6) Drug interaction. Theoretically, most appetite suppressants can stimulate adrenergic neurons to release norepinephrine and dopamine, and prevent these transmitters from being reabsorbed by nerve endings, thus leading to an increase in blood pressure and affecting the effect of antihypertensive drugs. However, the interference of common appetite suppressants on the action of common antihypertensive drugs has no obvious clinical significance. However, blood pressure should be monitored every week during the first 4 to 6 weeks of treatment. The combination of appetite inhibitor and monoamine oxidase inhibitor can lead to hypertensive crisis, because the latter can inhibit the oxidative inactivation of endogenous catecholamine and strengthen the role of such transmitters. Therefore, appetite suppressants should be banned for patients who have used any monoamine oxidase inhibitors within 2 weeks. Taking alkaline drugs at the same time can increase the plasma concentration of appetite suppressants, while urine acidulants can reduce the plasma concentration.
In short, under the guidance of experts, on the basis of diet, exercise and behavioral therapy, we should choose regular and appropriate drug-assisted treatment. Do not take diet pills as the main means, do not pay attention to diet, exercise and change behavior, so it is easy to rebound after stopping taking drugs.
Some people don't know enough about the harm of obesity and don't take the initiative to treat it, which will eventually lead to various chronic complications and seriously endanger their health. It is not worth taking to blindly pursue physical beauty and lose weight excessively.