Radeyah Waseem  ( 3rd year MBBS Student, Dow Medical College, Karachi, Pakistan. )
Mahnoor Raza  ( 3rd year MBBS Student, Dow Medical College, Karachi, Pakistan. )
Aleena Aftab  ( 3rd year MBBS Student, Dow Medical College, Karachi, Pakistan. )

DOI: https://doi.org/10.47391/JPMA.4261

 

Madam, sibutramine is an anti-obesity medication that is chemically related to amphetamines. It is mainly used to manage obesity due to its appetite-suppressing effect. The drug has gained a lot of popularity since it promotes a modest weight reduction. However, Sibutramine had some undesirable side-effects, headache, constipation and nausea being the most commonly reported, followed by dizziness, xerostomia and insomnia.¹ Even then, authorities surmised this drug to be more beneficial than harmful, and it was marketed in Pakistan.

However, a 2010 study published in The New England Journal of Medicine raised more significant concerns - it showed that Sibutramine administration caused a statistically significant rise in cardiovascular diseases.² The study had a huge impact on China, Canada, Australia, Mexico, New Zealand, Thailand, the European Union, Hong Kong, the Philippines, India, the United Kingdom, and the United States dismissing Sibutramine. To further accentuate the findings, a case report was published in Acute Medicine & Surgery in 2017, which showed that Sibutramine caused a 21-year-old female without any prior history of cardiovascular disease to develop cardiac arrest.³

With these findings, one can question the use of Sibutramine in Pakistan.

Anti-obesity drugs are quite popular in Pakistan since obesity is prevalent here. The findings of a study published in James Journal of Obesity & Metabolic Syndrome in March 2020 by Asif et al. demonstrated that 22.8% of the participants from the survey were overweight and 5.1% were obese.⁴ However, obesity is not the only main concern in society. Another study published in the American Heart Journal was conducted to determine the frequency of Coronary Artery Diseases (CAD) in Karachi, the most populated city of Pakistan. The prevalence of CAD was 26.9% overall, with 23.7% in men compared to 30.0% in women. The risk was uniformly higher in the young and in women.⁵ These statistics raise serious questions as to whether Sibutramine should be prescribed to a population already at a high risk of developing cardiovascular diseases should consider an alternate medicine.  Physicians need to be more vigilant when prescribing this drug and ensure a proper follow-up for patients at risk.

 

Disclaimer: None to declare.

Conflict of Interest: None to declare.

Funding Disclosure: None to declare.

 

References

 

1.      Nisoli E, Carruba MO. A benefit-risk assessment of sibutramine in the management of obesity. Drug Saf. 2003; 26:1027-48.

2.      James WP, Caterson ID, Coutinho W, Finer N, Van Gaal LF, Maggioni AP, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010; 363:905-17.

3.      Bunya N, Sawamoto K, Uemura S, Kyan R, Inoue H, Nishida J, et al. Cardiac arrest caused by sibutramine obtained over the Internet: a case of a young woman without pre-existing cardiovascular disease successfully resuscitated using extracorporeal membrane oxygenation. Acute Med Surg. 2017; 4:334-7.

4.      Asif M, Aslam M, Altaf S, Atif S, Majid A. Prevalence and Sociodemographic Factors of Overweight and Obesity among Pakistani Adults. J Obes Metab Syndr. 2020; 29:58-66.

5.      Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J. 2005; 150:221-6.