Obesity is a huge problem in this country (sorry). One third of Americans are significantly overweight, and overweight people have a whole Pandora’s Box of health problems.
Obesity causes elevated blood pressure, heart attacks, strokes and kidney failure. The extra weight wears out the joints in the legs so total knee and hip replacements are performed more frequently, and at a younger age, in the obese. Reassemble this box and the price tag adds up to $150 billion per year for obesity-caused disease, just in this country.
Think a few people are looking for an answer? We may have found one.
Qnexa is a combination of two older medications that appears to have somewhat magical and unexpected properties when put together in just the right amount.
The two medications that make up Qnexa are Phentermine (of fen-phen fame) and Topamax. Phentermine is an older diet medication, which is in the family of stimulants. Don’t worry, the heart problems in Fen-phen were all because of the Fenfluramine, which is no longer available.
Topamax is an anti-convulsant (anti-epileptic) that has been around a while and is used to treat migraines and chronic pain, as well as epilepsy. So you add these two medications, experiment with the right amount, and duration of each, and almost like magic, people start losing weight.
The magic seems to be in the details. The phentermine-to-Topamax ratio that is used is roughly 1 to 6. The actual dosages studied are anywhere from roughly 50% of maximum doses of each to merely 10%.
They have also adjusted the release of the medications to prolong the effect in the body (also allows once daily dosing).
Now, more than a few people will be thinking of making “do it yourself” Qnexa by getting a prescription for both medications – that would be a very bad idea.
The actual medication has been approved by the FDA advisory panel; but it took two times through to get that. The full FDA hasn’t approval this (necessary to allow your doctor to prescribe it). Approval is anticipated later this year. In the meantime, do-it-yourself pharmaceutical research is dicey at best.
Probably worth remembering that one of these medications has seen trouble before (fen-phen). There have also been a good dozen drugs taken off the market in the last 10 years for safety reasons, and they had been fully approved by the FDA.
Qnexa isn’t there yet.
But does it really work? Three large studies have looked into the safety and effectiveness of this medication. The FDA’s minimum “bar” for effectiveness (in a weight loss medication) is 5% weight loss after one year of therapy. Qnexa had no problem meeting that, and in fact had closer to 15% weight loss after a year’s therapy.
The mechanism of action is appetite suppression; you don’t get hungry.
There were no surprising side effects, most were mild and did not limit treatment. Side effects tended to be gastro-intestinal; some nausea, constipation and numbness and tingling in a rare patient.
Keep in mind that new medications and combinations are tested on a few thousand people, not the millions of people that a hot new prescription drug will see. Statistically rare occurrences require big numbers to identify. It is reassuring however, that there are no serious scientific concerns about this new combination medication.
Will Qnexa be the next big pharmaceutical wonder drug, the billion dollar pill? Will it undo some of the damage the fast food nation has done on our heart health? Or will having a good answer for weight loss just make us eat even less carefully?
I think next year’s New Year’s Resolution is going to be a lot easier to keep.
Take Care.
Dr B.