Prescription weight-loss drug

Study the pros and cons of medicines to treat obesity.

Are you an adult who has serious health problems because of your weight? Have you tried diet and exercise but haven't been able to lose enough weight? If you answered yes to these questions, a prescription weight-loss drug may be a choice for you.

Prescription drugs are medicines that a health care provider prescribes for you. You can't buy them off the shelf in a drug store like you can buy nonprescription medicines.

Just know that you need to use prescription weight-loss drugs in addition to — not instead of — a healthy diet and exercise.

Who can take weight-loss drugs?

Your health care provider may suggest a weight-loss drug for you in some cases. These include if you haven't been able to lose weight through diet and exercise and your:

• Body mass index (BMI) is greater than 30. This means you're living with a condition that involves having too much body fat, called obesity.
• BMI is greater than 27. You also have a serious medical problem linked to obesity, such as diabetes or high blood pressure.

Before choosing a medicine for you, your health care provider thinks about your history and health challenges. Then your provider talks with you about the pros and cons of prescription weight-loss drugs.

These drugs aren't for everyone. For example, you shouldn't take prescription weight-loss drugs if you're trying to get pregnant, are pregnant or are breastfeeding.

How well do weight-loss drugs work?

Prescription weight-loss drugs that you can use for more than 12 weeks, called long-term use, lead to major weight loss compared with an inactive treatment that doesn't use medicine, called a placebo. The combination of weight-loss medicine and lifestyle changes leads to greater weight loss than do lifestyle changes alone.

Taking these drugs for a year can mean a loss of total body weight of 3% to 12% more than that lost with lifestyle changes alone. That may not seem like a lot. But losing 5% to 10% of your total weight and keeping it off can have important health benefits. For example, it can lower blood pressure, blood sugar levels and levels of fats in the blood called triglycerides.

What you should know about weight-loss drugs

Mild side effects, such as nausea, constipation and diarrhea, are common. They may lessen over time. Rarely, serious side effects can happen. That's why it's important to ask your health care provider about all treatment choices. And ask about the possible benefits and risks of each drug.

Weight-loss drugs can be expensive and aren't always paid for by insurance. Ask your insurance company about your coverage.

Many people gain back some of the weight they lost when they stop taking weight-loss drugs. But practicing healthy lifestyle habits may help limit weight gain.

How long do I take a weight-loss drug?

How long you take a weight-loss drug depends on whether the drug helps you lose weight. If you've lost enough weight to improve your health and you haven't had serious side effects, your health care provider may suggest that you take the drug long term.

If you haven't lost at least 5% of your body weight after taking the full dose of a drug for 3 to 6 months, your health care provider will probably change your treatment. They may switch you to a different weight-loss drug.

What drugs are approved for weight loss?

Six weight-loss drugs have been approved by the U.S. Food and Drug Administration (FDA) for long-term use:

• Bupropion-naltrexone (Contrave)
• Liraglutide (Saxenda)
• Orlistat (Xenical, Alli)
• Phentermine-topiramate (Qsymia)
• Semaglutide (Wegovy)
• Setmelanotide (Imcivree)

Most prescription weight-loss drugs work by making you feel less hungry or fuller. Some do both. The exception is orlistat. It affects the way your body absorbs fat.

Bupropion-naltrexone

Bupropion-naltrexone is a combination drug. Naltrexone is used to treat alcohol and opioid addiction. Bupropion is a drug to treat depression, called an antidepressant, and a drug to help people stop smoking, called a quit-smoking aid. Like all antidepressants, bupropion carries a warning about suicide risk. Bupropion-naltrexone can raise blood pressure. So your provider will need to check your blood pressure regularly at the start of treatment. Common side effects include nausea, headache and constipation.

Liraglutide

Liraglutide also is used to manage diabetes. It's given as a daily shot. Nausea is a common complaint. Vomiting may limit its use.

Orlistat

You also can get orlistat in a reduced-strength form without a prescription (Alli). Orlistat can cause side effects such as passing gas and having loose stools. You need to follow a low-fat diet when taking this medicine. In rare cases, people have had serious liver injury with orlistat. But researchers haven't found that the drug causes liver injuries.

Phentermine-topiramate

Phentermine-topiramate is a combination of a weight-loss drug called phentermine and an anticonvulsant called topiramate. Phentermine has the potential to be misused because it acts like a stimulant drug called an amphetamine. Other possible side effects include an increase in heart rate and blood pressure, insomnia, constipation, and nervousness. Topiramate increases the risk of birth defects.

Phentermine by itself (Adipex-P, Lomaira) also is used for weight loss. It's one of four similar weight-loss drugs approved for use for less than 12 weeks, called short-term use. The other drugs in this group aren't often prescribed.

Semaglutide

Semaglutide also is used to help control type 2 diabetes. You take it as a weekly shot to manage obesity.

It can cause side effects such as:

• Nausea and vomiting
• Diarrhea
• Belly pain
• Headache
• Tiredness

Setmelanotide

The FDA has approved setmelanotide only for people age 6 and older who have obesity due to one of these rare inherited conditions:

• Pro-opiomelanocortin deficiency
• Proprotein subtilisin-kexin type 1 deficiency
• Leptin receptor deficiency

To take the drug, you'll need to have test results that show you have one of these conditions. Setmelanotide doesn't treat any of the gene problems that cause these conditions. But it can help you lose weight. It can lessen your appetite and make you feel fuller. And it may help you burn calories while your body is at rest.

You take setmelanotide as a daily shot. It can cause side effects such as:

• Swollen or irritated skin where the needle went in
• Patches of darker skin
• Nausea
• Diarrhea
• Belly pain
• Unwanted sexual reactions
• Depression
• Suicidal thoughts

Never give setmelanotide to a child under 6 years old. It can cause newborns and babies to have dangerous reactions.

The bottom line

Weight-loss drugs aren't an easy answer to weight loss. But they may help you make the lifestyle changes that you need to practice to lose weight and improve your health. 

Source Article: Prescription weight-loss drug

Botox: The Cosmetic Use of Botulinum Toxin

What is Botox Cosmetic?

Botox Cosmetic is an injectable wrinkle muscle relaxer. It uses botulinum toxin type A, specifically OnabotulinumtoxinA, to temporarily paralyze muscle. This reduces the appearance of facial wrinkles.

A Botox treatment is minimally invasive. It’s considered a safe, effective treatment for fine lines and wrinkles around the eyes. It can also be used on the forehead between the eyes.

Botox was originally FDA approved in 1989 for the treatment of blepharospasm and other eye muscle problems. In 2002, the FDA approved the use of Botox for a cosmetic treatment for moderate to severe frown lines between the eyebrows. It was approved by the FDA for treatment of wrinkles around the corners of the eyes (crow’s feet) in 2013.

According to a 2016 clinical study, Botox is a simple, safe, and effective treatment for reduction of forehead wrinkles.

In 2016, over 4.5 million procedures were performed using Botox and similar medication to fight wrinkles. This type of procedure is the number one nonsurgical cosmetic procedure in the United States.

Preparing for Botox Cosmetic

Botox Cosmetic involves a nonsurgical, in-office treatment. It requires minimal preparation. You should let your treatment provider know about your medical history, allergies, or medical conditions before your procedure. Your treatment provider should be a licensed physician, a physician assistant, or a nurse.

You might need to remove all your makeup and cleanse the treatment area before the procedure. You may also need to avoid blood-thinning medicine like aspirin to reduce the risk of bruising.

What areas of the body can be treated with Botox Cosmetic?

Cosmetically, the injectable can be used in the following areas:

• the area between the eyebrows (glabellar region), to treat moderate to severe frown lines
• around the eyes, commonly known as crow’s feet lines

Botox also received FDA approval to treat various medical problems, including:

• overactive bladder
• excessive underarm sweating
• lower limb spasticity
• chronic migraines

How does Botox Cosmetic work?

Botox Cosmetic works by temporarily blocking nerve signals and muscle contractions. This improves the appearance of wrinkles around the eyes and between the eyebrows. It can also slow the formation of new lines by preventing contraction of facial muscles.

It’s a minimally invasive procedure. It doesn’t involve incisions or general anesthesia. If you’re concerned about pain or discomfort, a topical anesthetic or ice can numb the treatment area.

During the procedure, your provider will use a thin needle to administer 3-5 injections of botulinum toxin type A. They will inject the targeted area between the eyebrows. You will usually need three injections on the side of each eye to smooth out crow’s feet.

The entire procedure takes approximately 10 minutes.

Are there any risks or side effects?

Minor bruising or discomfort may occur, but should improve within a few days. Other side effects may include:

• swelling or drooping in the eyelid area
• tiredness
• headache
• neck pain
• double vision
• dry eyes
• allergic reactions, such as rash, itching, or asthma symptoms

Contact your provider immediately if any of these side effects occur.

What to expect after Botox Cosmetic

Avoid rubbing, massaging, or applying any pressure to the treated area. These actions can cause Botox Cosmetic to spread to other areas of the body. This can negatively affect your results. When being injected between the brows, do not lie down or bend over for three to four hour. Doing so may cause the Botox to slip under the orbital rim. This could possibly cause an eyelid droop.

There is little to no downtime expected after the treatment. You should be able to resume normal activities immediately in most cases.

It’s important to understand possible improvements and have realistic expectations. Noticeable results can be expected within 1-2 days post-treatment. The full effect of Botox Cosmetic typically lasts up to four months. It can also help prevent the return of fine lines through relaxing the muscles.

Additional Botox injections can be administered to maintain your results.

How much does Botox Cosmetic cost?

The average cost of a botulinum toxin treatment such as Botox Cosmetic was $376 in 2016. Costs may vary depending on the number of injections, the size of the treatment area, and the geographic location where you receive treatment.

Botox Cosmetic is an elective procedure. Health insurance does not cover the cost when used for cosmetic reasons.

Outlook

Botox Cosmetic is FDA approved for the reduction of fine wrinkles around the eyes and on the forehead. It’s relatively safe and noninvasive.

When choosing a provider, confirm that they’re licensed to administer Botox Cosmetic. Let your provider know about any allergies or medical conditions, and call them right away if you experience any side effects following your treatment. Results should last for about four months, and it’s possible to have additional injections to maintain the reduction of your wrinkles. 

Article Source: Botox: The Cosmetic Use of Botulinum Toxin

Hormone Therapy for Menopause Symptoms

Hormone therapy (HT) is used to treat symptoms of menopause. Your age, family medical history, personal medical history and severity of your menopausal symptoms are factors that may affect your decision to take hormone therapy. Talk with your healthcare about the benefits and risks of HT, the different forms of HT and other alternative options.

OVERVIEW

What are estrogen and progesterone?

Estrogen and progesterone are hormones that are produced by a woman’s ovaries.

What does estrogen do?

Estrogen plays a role in many body functions, including:

• Thickens the lining of your uterus, preparing it for the possible implantation of a fertilized egg.
• Influences how your body uses calcium, an important bone-building mineral.
• Helps maintain healthy blood cholesterol levels.
• Keeps your vagina healthy.
• Helps prevent osteoporosis.

What does progesterone do?

Progesterone plays a role in many body functions, including:

• Helps prepare your uterus for the implantation of a fertilized egg and maintains your pregnancy.
• Regulates blood pressure.
• Improves mood and sleep.

What is hormone therapy (HT)?

As you begin to transition into menopause, your ovaries no longer produce high levels of estrogen and progesterone. Changes in these hormone levels can cause uncomfortable symptoms. Common menopause symptoms include:

• Hot flashes.
• Night sweats and/or cold flashes.
• Vaginal dryness; discomfort during sex.
• Feeling a need to pee (urinary urgency).
• Trouble sleeping (insomnia).
• Mood swings, mild depression or irritability.
• Dry skin, dry eyes or dry mouth.

Hormone therapy (HT) is used to boost your hormone levels and relieve some of the symptoms of menopause. Whether or not you should consider taking HT therapy is a discussion to have with your healthcare provider. There are many health benefits and risks associated with taking HT.

What are the types of hormone therapy (HT)?

There are two main types of hormone therapy (HT):

• Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
• Estrogen Progesterone/Progestin Hormone Therapy (EPT): Also called combination therapy, this form of HT combines doses of estrogen and progesterone (or progestin, a synthetic form of progesterone).

Does having or not having a uterus make a difference in deciding what type of hormone therapy I should take?

Yes, it does.

If you still have your uterus:

Progesterone is used along with estrogen. Taking estrogen without progesterone increases your risk for cancer of the endometrium (the lining of the uterus). During your reproductive years, cells from your endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.

Progesterone reduces the risk of endometrial (uterine) cancer by making the endometrium thin. If you take progesterone, you may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously.

If you no longer have your uterus (you’ve had a hysterectomy):

You typically won't need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.

PROCEDURE DETAILS

What are some commonly used postmenopausal hormones?

The following list provides the names of some, but not all, postmenopausal hormones.

Estrogen

• Pills, Brand names: Cenestin®, Estinyl®, Estrace®, Menest®, Ogen®, Premarin®, Femtrace®.
• Creams, Brand names: Estrace®, Ogen®, Premarin®.
• Vaginal ring, Brand names: Estring®, Femring® (treats vaginal symptoms and hot flashes).
• Vaginal tablet, Brand names: Vagifem®. Imvexxy®
• Patch, Brand names: Alora®, Climara®, Minivelle®, Estraderm®, Vivelle®, Vivelle-Dot®, Menostar®.
• Spray, Brand name: Evamist®.

Combination EPT

• Pills, Brand names: Activella®, FemHRT®, Premphase®, Prempro®, Angeliq®, Bijuva®.
• Patch, Brand names: CombiPatch®, Climara-Pro®.

          Vaginal dehydroepiandrosterone (DHEA)

• Vaginal insert, Brand name: Intrarosa®

RISKS / BENEFITS

What are the benefits of taking hormone therapy (HT)?

Hormone therapy (HT) is prescribed to relieve menopausal symptoms including:

• Hot flashes.
• Vaginal dryness that can result in painful intercourse.
• Other problematic symptoms of menopause, such as night sweats and dry, itchy skin.

Other health benefits of taking HT include:

• Reduced risk of developing osteoporosis and reduced risk of breaking a bone.
• Improved mood and overall sense of mental well-being in some women.
• Decreased tooth loss.
• Lowered risk of colon cancer.
• Lowered risk of diabetes.
• Modest improvement in joint pains.
• Lower death rate for women who take hormone therapy in their 50s.

What are the risks of taking hormone therapy (HT)?

While hormone therapy (HT) helps many women get through menopause, the treatment (like any prescription or even non-prescription medicines) is not risk-free. Known health risks include:

• An increased risk of endometrial cancer (only if you still have your uterus and are not taking a progestin along with estrogen).
• Increased risk of blood clots and stroke.
• Increased chance of gallbladder/gallstone problems.
• Increased risk of dementia if hormone therapy is started after midlife. HT started during midlife is associated with a reduced risk of Alzheimer’s disease and dementia.
• Increased risk of breast cancer with long-term use.

What is known about hormone therapy and the risk of heart disease?

Scientists continue to learn about the effects of HT on the heart and blood vessels. Many large clinical trials have attempted to answer questions about HT and heart disease. Some have shown positive effects in women who started HT within 10 years of menopause; some have shown negative effects when started greater than 10 years of menopause. Some studies have raised more questions about the potential benefits of HT.

Based on the data, the American Heart Association issued a statement for use of HT. They say:

• Hormone therapy for the sole purpose of preventing heart disease (specifically heart attack or stroke) is not recommended.

What is known about hormone therapy and the risk of breast cancer?

Taking combined hormone therapy can increase your risk of developing breast cancer. Here are some important findings:

• Taking combination hormone therapy showed a rare increase of absolute risk of less than one additional case of breast cancer per 1000 person years of use.
• There was a nonsignificant reduction in breast cancer seen in women with hysterectomies on estrogen only therapy.
• If you’ve been diagnosed with breast cancer you should not take systemic hormone therapy.

Who shouldn't take hormone therapy (HT)?

Hormone therapy (HT) is not usually recommended if you:

• Have or had breast cancer or endometrial cancer.
• Have abnormal vaginal bleeding.
• Have had blood clots or are at high risk for them.
• Have a history of stroke, heart attack or increased risk for vascular disease.
• Know or suspect you’re pregnancy.
• Have liver disease.

What are the side effects of hormone therapy (HT)?

Like almost all medications, hormone therapy has side effects. The most common side effects are:

• Monthly bleeding (if you have a uterus and take cycled progestin [estrogen for 25 days of estrogen/month, progesterone for last 10 to 14 days/month, 3 to 6 days of no therapy]).
• Irregular spotting.
• Breast tenderness.
• Mood swings.

Less common side effects of hormone therapy include:

• Fluid retention.
• Headaches (including migraine).
• Skin discoloration (brown or black spots).
• Increased breast density making mammogram interpretation more difficult.
• Skin irritation under estrogen patch.

How can I reduce these side effects of hormone therapy (HT)?

In most cases, these side effects are mild and don’t require you to stop your HT. If your symptoms bother you, ask your healthcare provider about adjusting either the dosage or the form of the HT to reduce the side effects. Never make changes in your medication or stop taking it without first consulting your provider.

RECOVERY AND OUTLOOK

How long should I take hormone therapy (HT)?

In general, there is no time limit to how long you can take hormone therapy. You should take the lowest dose of hormone therapy that works for you, and continue routine monitoring with your healthcare provider to reevaluate your treatment plan each year. If you develop a new medical condition while taking HT, see your provider to discuss if it’s still safe to continue taking HT.

A note from Cleveland Clinic

The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. You’ll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.

Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.

 Article Source: Hormone Therapy for Menopause Symptoms