Drugs On Review

Archive for the ‘Reuptake Inhibitor’ Category

What is Meridia?

Meridia is a trade name for sibutramine, a serotonin-norepinephrine reuptake inhibitor used to suppress appetite in cases of obesity. It was originally launched by Knoll Pharmaceuticals before being marketed by Abbott Laboratories. Meridia is chemically related to amphetamine although it has a different mechanism of action. The drug has been controversial since its introduction and was withdrawn in the United States and other major markets in 2010 after being associated with increased risk of cardiovascular incidents and strokes.

Meridia acts in the central nervous system by increasing the levels of serotonin, norepinephrine and dopamine. This promotes a sense of satiety and sends a signal to stop eating.

What does Meridia look like?

Meridia was sold in a blue and white capsule with a strength of 10 mg and the imprint “Meridia 10” and a yellow and white capsule with a strength of 15 mg and the imprint “Meridia 15”.

Meridia dosing and administration

The recommended initial dosage of Meridia for appetite control in the loss or maintenance of weight is 10 mg once daily. This may be increased to 15 mg if insufficient weight has been lost after taking Meridia and eating a reduced diet for four weeks. If side effects become a problem with Meridia, your doctor may reduce your dosage to 5 mg once daily. Meridian may be taken with or without food. It should be combined with a low-calorie diet and is not intended to be used without a restriction of food intake.

Common adverse effects from Meridia

In clinical trials before the release of Meridia, the most common side effects were found to be headaches, anorexia, constipation, insomnia, stuffy or runny nose and sore throat. Less common side effects included back pain, fever, chills and muscle ache, weakness, abdominal pain, flushing, migraine, increased appetite, nausea, dyspepsia, joint pain, dizziness, nervousness, sinus infections, coughing, sweating, taste disturbances, painful menstrual periods and urinary tract infections. More serious side effects which occur less frequently include hypertension, tachycardia, palpitations, seizures, serotonin syndrome, unusual bleeding, gallstones, depression and anxiety.

Meridia warnings and precautions

You should tell your doctor before taking Meridia if you have hypertension, heart problems, a history of stroke, liver or kidney disease, glaucoma, epilepsy, any bleeding disorder, gallstones, depression, anorexia nervosa or bulimia, a history of substance abuse including alcohol or any allergies. You should inform your doctor if you are or may become pregnant or if you are breastfeeding. Serotonin syndrome is more likely to occur if meridian is taken with other medications which affect the serotonin system. These include SSRI antidepressants, some migraine medications and other drugs.

Interactions with Meridia

Meridia may interact with some antibiotics and antifungals, some pain medications such as tramadol and fentanyl, allergy medications, ergot-derived medications for migraine, lithium, monoamine oxidase inhibitors (MAOIs), other weight loss medications, SSRI or SNRI drugs including fluoxetine (Prozac) and Sertaline (Zoloft), St John’s wort, tricyclic antidepressants, triptans and tryptophan. A number of over-the-counter cough and cold medications may cause dangerous interactions with Meridia.

What is Priligy?

Priligy is a brand name for dapoxetine, a short-acting selective serotonin reuptake inhibitor which is used for the treatment of premature ejaculation. It is the only drug which has been approved for this purpose. However it has been refused approval by the US FDA. It is under consideration in a number of European countries and is already on sale in Finland, Sweden, Portugal, Austria, Italy and Germany. The drug was developed by Lilly as an antidepressant before being sold to Johnson and Johnson in 2003. The following year it was submitted to the FDA for approval. After being refused, further clinical trials of the drug were concluded in 2006 and the application resubmitted. At present, Priligy is under review by the European Union, Canada, Australia, Mexico, Turkey and other countries.

All SSRI drugs are essentially antidepressants which work by reducing the reuptake of serotonin in the synaptic gap so that more free serotonin is available to bind with serotonin receptors. This has an anxiolytic effect. SSRIs such as fluoxetine (Prozac) have been prescribed off-label to men suffering from premature ejaculation. However they have a long cycle of absorption and excretion, usually requiring days or weeks to reach peak serum concentration. Dapoxetine was originally developed as an antidepressant but was found to have an extremely short half life which means that it reaches peak serum level within about an hour and a half and is cleared from the body within a matter of hours. This makes it extremely useful for the on-demand treatment of premature ejaculation.

What does Priligy look like?

Priligy is sold as a round blue pill in strengths of 30 and 60 mg, imprinted with the strength in milligrams.

Priligy dosing and administration

The standard starting dose of Priligy is 30 mg to be taken between one and three hours before six. If no improvement is noted at this dosage, your doctor may increase the dose. Only one dose of Priligy should be taken within a 24 hours period. Priligy may be taken with or without food but the use of alcohol should be avoided.

Common adverse effects from Priligy

The most common side effects of Priligy are nausea, vertigo, headache and diarrhea. Less frequent adverse effects are irritability, numbness, abdominal pain, indigestion and excessive sweating. If any other side effects occur while taking Priligy seek immediate medical assistance. Like all SSRIs, the use of Priligy may result in serotonin syndrome. Other side effects may include dry mouth, jaw clenching, nasal congestion, paranoia and erectile dysfunction.

Interactions with Priligy

Priligy is not known to interact with other drugs. Laboratory studies have shown an increase in AUC when priligy is taken with 100 mg of sildenafil (Viagra) but this is described as not being clinically significant. There appears to be no interaction with alcohol. There may be an increased incidence of nausea when taken together with either tadalafil (Cialis) or sildenafil.