The term is (from the Greek ἀν- (an-) = “without” and ὄρεξις (órexis) = “appetite”), and such drugs are also known as anorexigenic, anorexiant, or appetite suppressant.
Used on a short-term basis clinically to treat obesity, some appetite suppressants are also available over-the-counter. Most common natural appetite suppressants are based on Hoodia, a genus of 13 species in the flowering plant family Apocynaceae, under the subfamily Asclepiadoideae. Several appetite suppressants are based on a mix of natural ingredients, mostly using green tea as its basis, in combination with other plant extracts such as fucoxanthin, found naturally in seaweed. Drugs of this class are frequently stimulants of the phenethylamine family, related to amphetamine (informally known as speed).
The German and Finnish militaries issued amphetamines to soldiers commonly to enhance warfare during the Second World War. Following the war, amphetamines were redirected for use on the civilian market. Indeed, amphetamine itself was sold commercially as an appetite suppressant until it was outlawed in most parts of the world in the late 1950s because of safety issues. Many amphetamines produce side effects, including addiction, tachycardia and hypertension, making prolonged unsupervised use dangerous.
Public health concerns
Epidemics of fatal pulmonary hypertension and heart valve damage associated with pharmaceutical anorectic agents have led to the withdrawal of products from the market. This was the case with aminorex in the 1960s, and again in the 1990s with fenfluramine (see: Fen-phen). Likewise, association of the related appetite suppressant phenylpropanolamine with hemorrhagic stroke led the Food and Drug Administration (FDA) to request its withdrawal from the market in the United States in 2000, and similar concerns regarding ephedrine resulted in an FDA ban on its inclusion in dietary supplements in 2004. A Federal judge later overturned this ban in 2005 during a challenge by supplement maker Nutraceuticals. It is also debatable as to whether the ephedrine ban had more to do with its use as a precursor in methamphetamine manufacture rather than health concerns with the ingredient as such.
Weight loss effects of water have been subject to some scientific research. Drinking water prior to each meal may help in appetite suppression. Consumption of 500 mL (approximately 17 fl oz) of water 30 minutes before meals has been correlated with modest weight loss (1–2 kg) in obese men and women over a period of 8 to 12 weeks.
List of anorectics
Numerous pharmaceutical compounds are marketed as appetite suppressants.
The following drugs listed as “centrally-acting antiobesity preparations” in the Anatomical Therapeutic Chemical Classification System:
- Amfepramone (also known as diethylpropion)
- Bupropion and naltrexone (combination)
- Dexfenfluramine† (the D-enantiomer of fenfluramine; withdrawn for the same reason as its racemate)
- Ephedrine (combinations)
- Fenfluramine† (one of the two components [the other being phentermine] of Fen-phen. Since discontinued to its potential for causing valvulopathies and pulmonary hypertension)
- Sibutramine† (in some countries withdrawn from the market because of concerns regarding its cardiovascular effects)
- Phenmetrazine† (withdrawn in some countries due to the danger of addiction)
Other compounds with known appetite suppressant activity include:
- Amphetamine sulfate (also known as amfetamine) – USFDA-approved for the treatment of exogenous obesity under the brand name “Evekeo”.
- Methamphetamine hydrochloride – USFDA-approved for the treatment of obesity (as a short-term) under the brand name “Desoxyn”.
- Lemke, Thomas L.; Williams, David A., eds. (2012). “Anorexiants as Pharmacologic Agents in the Management of Obesity”. Foye’s Medicinal Chemistry. pp. 1451–6. ISBN 978-1-60913-345-0.
- Ulrich, Andreas (May 6, 2005). “The Nazi Death Machine: Hitler’s Drugged Soldiers”. Spiegel Online. Retrieved 2011-01-05.
- Abenhaim, Lucien; Moride, Yola; Brenot, François; Rich, Stuart; Benichou, Jacques; Kurz, Xavier; Higenbottam, Tim; Oakley, Celia; Wouters, Emil; Aubier, Michel; Simonneau, Gérald; Bégaud, Bernard (1996). “Appetite-Suppressant Drugs and the Risk of Primary Pulmonary Hypertension”. New England Journal of Medicine. 335 (9): 609–16. doi:10.1056/NEJM199608293350901. PMID 8692238.
- Fishman, A. P. (1999). “Aminorex to Fen/Phen : An Epidemic Foretold”. Circulation. 99 (1): 156–61. doi:10.1161/01.cir.99.1.156. PMID 9884392.
- Handbook of Non Drug Intervention (HANDI) Project Team (2013). “Pre-meal water consumption for weight loss”. Australian Family Physician. 42 (7): 478. PMID 23826600.
- Dennis, Elizabeth A.; Dengo, Ana Laura; Comber, Dana L.; Flack, Kyle D.; Savla, Jyoti; Davy, Kevin P.; Davy, Brenda M. (2009). “Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle-aged and Older Adults”. Obesity. 18 (2): 300–7. doi:10.1038/oby.2009.235. PMC 2859815. PMID 19661958.
- Vij, Vinu Ashokkumar; Joshi, Anjalis (2014). “Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants”. Journal of Natural Science, Biology and Medicine. 5 (2): 340–4. doi:10.4103/0976-9668.136180. PMC 4121911. PMID 25097411.
- ATC/DDD Index
- MeSH list of agents 82001067
- “Evekeo Prescribing Information” (PDF). Arbor Pharmaceuticals LLC. April 2014. pp. 1–2. Retrieved 9 January 2017.
- Wood, Douglas M; Emmett-Oglesby, Michael W (1988). “Substitution and cross-tolerance profiles of anorectic drugs in rats trained to detect the discriminative stimulus properties of cocaine”. Psychopharmacology. 95 (3): 364–8. doi:10.1007/BF00181948. PMID 3137623.
- “Desoxyn Prescribing Information” (PDF). United States Food and Drug Administration. December 2013. Retrieved 9 January 2017.
- Anorectics at the US National Library of Medicine Medical Subject Headings (MeSH)
- Mitchell, Kari (January 1997). “Anorexiant Agents: Considerations for Use” (PDF). Drug Therapy Topics. University of Washington Medical Center. Retrieved 25 December 2013.