There can be variation in the licensing of
different medicines containing the same drug.
Solution for injection
▶Glypressin (Ferring Pharmaceuticals Ltd)
Terlipressin acetate 120 microgram per 1 ml Glypressin 1mg/8.5ml
solution for injection ampoules | 5 ampoule P s
▶Variquel (Alliance Pharmaceuticals Ltd)
Terlipressin acetate 200 microgram per 1 ml Variquel 1mg/5ml
solution for injection vials | 5 vial P £89.98 (Hospital only)
Obesity
Gastro-intestinal system
Obesity
Description of condition
Obesity is directly linked to many health problems including
cardiovascular disease, type 2 diabetes, fatty liver disease,
gallstones, and gastro-oesophageal reflux disease. It is also
linked to psychological and psychiatric morbidities.
In adults, obesity is generally classified as a body mass
index (BMI) of 30 kg/m2, though BMI should be interpreted
with caution as it is not a direct measure of adiposity,
particularly in patients who are very muscular or have
muscle weakness or atrophy.
Waist circumference should also be considered as it may
provide an indication of total body fat and a risk of obesity-
related health problems. Men with a waist circumference
94 cm ( 90 cm for Asian men), and women with a waist
circumference of 80 cm are at increased risk of obesity-
related health problems. A waist circumference of 102 cm
in men and 88 cm in women indicates a very high risk of
obesity-related health problems.
Aims of treatment
Management should be aimed at modest, sustainable weight
loss and maintenance of a healthy weight, to reduce the risk
factors associated with obesity.
Overview
g Obesity should be managed in an appropriate setting
by staff who have been trained in the management of
obesity. Patients should be monitored for changes in weight,
as well as changes in blood pressure and blood lipids, and for
other associated conditions.
An initial assessment should consider potential underlying
causes (e.g. hypothyroidism) and a review of the
appropriateness of current medications which are known to
cause weight gain, e.g. atypical antipsychotics, beta-
adrenoceptor blocking drugs, insulin (when used in the
treatment of type 2 diabetes), lithium carbonate, lithium
citrate, sodium valproate, sulphonylureas,
thiazolidinediones, and tricyclic antidepressants. h
Lifestyle changes
g Patients should be encouraged to engage in a
sustainable weight management programme which includes
strategies to change behaviour, increase physical activity,
and improve diet and eating behaviour. h
Drug treatment
g Drug treatment should never be used as the sole
element of treatment and should be used as part of an
overall weight management plan. An anti-obesity drug
should be considered only for those with a BMI of
30 kg/m2, in whom diet, exercise and behaviour changes
fail to achieve a realistic reduction in weight. In the presence
of associated risk factors, it may be appropriate to prescribe
an anti-obesity drug to individuals with a BMI of 28 kg/m2.
A vitamin and mineral supplement may also be considered if
there is concern about inadequate micronutrient intake,
particularly for vulnerable groups such as in the elderly and
younger patients.
The effect of management should be monitored on a
regular basis with reinforcement of supporting lifestyle
advice. Rates of weight loss may be slower in patients with
type 2 diabetes, so less strict goals than in those without
diabetes may be appropriate.
Orlistat p. 99, is the only drug currently available in the UK
that is recommended specifically for the management of
obesity; it acts by reducing the absorption of dietary fat.
Orlistat is licensed for use as an adjunct in the management
of obesity in patients with a BMI of 30 kg/m2, or, in
individuals with a BMI of 28 kg/m2 in the presence of other
risk factors. Treatment with orlistat may also be used to
maintain weight loss rather than to continue to lose weight.
Discontinuation of treatment with orlistat should be
considered after 12 weeks if weight loss has not exceeded 5%
since the start of treatment. h
Drugs which produce a feeling of satiety (such as
methylcellulose p. 59 and sterculia p. 59 [unlicensed
indications]) have been used in an attempt to control
appetite, but there is little evidence for their efficacy.
Various centrally acting appetite suppressants, including
stimulants and serotonergic drugs (such as dexfenfluramine,
fenfluramine, sibutramine, and rimonabant), have been used
in the management of obesity but have been withdrawn or
are no longer recommended due to serious safety concerns
or their addictive potential.
Surgery
g Bariatric surgery may be considered for patients who
have a BMI of 40 kg/m2 (Obesity III, morbid obesity), or
between 35–39.9 kg/m2 (Obesity II) and a significant disease
(such as type 2 diabetes or high blood pressure) which could
be improved with weight loss, and if all appropriate non-
surgical measures have been tried but clinically beneficial
weight loss has not been achieved or maintained. h
Useful Resources
Obesity: identification, assessment and management.
Clinical Guideline 189. National Institute for Health and
Care Excellence. November 2014.
www.nice.org.uk/guidance/cg189
Other drugs used for Obesity Liraglutide, p. 737
ANTIDEPRESSANTS › SEROTONIN AND
NORADRENALINE RE-UPTAKE INHIBITORS
PDF pages 119, 120
