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Weight loss

medications
Prepared by: Dr. Wael El-Said
DBK pharm a

Competitors Competitors
… …
1. Reductil (Meredia)
Mechanism of action
Active ingredient:
Each REDUCTIL (MERIDIA) capsule contains 5
mg, 10 mg, and 15 mg of sibutramine
hydrochloride monohydrate.

Mechanism of action:
Sibutramine is a centrally acting appetite
suppressant. it produces its therapeutic effects
by inhibiting the reuptake of norepinephrine,
serotonin and dopamine.
Acting On CNS

CNS Toxicity
Dose?!
 The recommended starting dose of MERIDIA
is 10mg administered once daily with or
without food.
 If there is inadequate weight loss, the dose
may be titrated after four weeks to a total of
15 mg once daily.
 Blood pressure and heart rate changes
should be taken into account when making
decisions regarding dose titration>
How to use it?!
 Take by mouth exactly as directed by your doctor,
usually once daily. The full effect on weight may
require four to six weeks.
 Do not increase your dose, take it more frequently or
use it for a longer period of time than prescribed
because this drug can be habit-forming.
 Also, if used for a longer period of time, do not
suddenly stop using this drug without your doctor's
approval.
 Over time, this drug may not work as well as it did at
the beginning. Consult your doctor if weight
increases.
Side effects:

Headache
30.3%
Side effects:

Hypertension,
Tachycardia &
arrhythmia 6.6%
Side effects:

Insomnia
10.7%
Side effects:

Injury accident
6%
Side effects:

Pack Pain 8.2%


Side effects:

Flu syndrome,
rhinitis &
pharyngitis 25.2%
Side effects:

Constipation
10.7%
Dizziness 7.0%
Increased appetite
8.7%
Side effects:
Side effects:
Side effects:
Side effects:
1. Common side effects
 anxiety

 dryness of mouth

 headache

 irritability or impatience

 constipation

 dizziness

 nervousness

 stuffy nose

 difficulty sleeping
2. Less common side effects:
- abdominal pain - back pain
- increased sweating - increased
thirst
- indigestion - nausea
- change in sense of taste - diarrhea

- burning, itching, prickling, or tingling of


skin
- drowsiness increase in appetite

- unusual warmth or flushing of skin

- Tachycardia or irregular heartbeat


- increased blood pressure

- psychological depression

- Dysmenorrhea

- Edema of body or of feet and ankles


3. Rare side effects:
 bruising on the body

 red spots or patches on skin

 convulsions (seizures)

 excessive bleeding following injury

 severe headache (severe)

 mood swings

 skin rash

 weight gain
% of side effects
Contraindications:
 MERIDIA is contraindicated in patients
receiving monoamine oxidase inhibitors
(MAOIs).
 MERIDIA is contraindicated in patients who
have a major eating disorder (anorexia
nervosa or bulimia nervosa).
 MERIDIA is contraindicated in patients
taking other centrally acting appetite
suppressant drugs.
See the difference with
Chitocal
 No serious side effects.
 No depression, anxiety or insomnia
 No cardiac affection.
 No mouth dryness.
 No diet restriction is needed.
 No dependence or intolerance.
 Weight loss starts from the 1st week
 No weight gain…..??!!!
 No obsolete contraindications.
Simple speaking.. Chitocal
is:

 Safe for all populations.


 Effective from the 1st week.
 No diet restriction.
 No monitoring is needed with the
treatment period.
 More economic.
2. Xenical (Orlistat)
Active ingredient:
Each Xenical capsule contains 120 mg orlistat.

 Mechanism of action:
Xenical is an inhibitor of gastrointestinal lipases . It
exerts its therapeutic activity in the lumen of the
stomach and small intestine by forming a bond with
the active site of gastric and pancreatic lipases. The
inactivated enzyme is thus unable to hydrolyse
dietary fat, into absorbable free fatty acids and
monoglycerides. As undigested triglycerides are not
absorbed, the resulting caloric deficit has a positive
effect on the weight control..
Dose:

 The recommended dose of Xenical is


one 120 mg capsule with each main
meal .
 If a meal is missed or contains no fat,
the dose of Xenical may be omitted.
How to use it?!

 The patient should be on a nutritionally


balanced, hypocaloric diet that contains
approximately 30% of calories from fat. It is
recommended that the diet should be rich in
fruit and vegetables.
 The daily intake of fat, carbohydrate and
protein should be distributed over three main
meals.
 Based on faecal fat measurements, the
effect of Xenical is seen as soon as 24 to 48
hours after dosing.
Xenical safety:
 Hepatic and/or Renal Impairment:
Clinical investigations in patients with
hepatic and/or renal impairment have not
been undertaken.
 Children below the age of 18 years

The safety and efficacy of Xenical in children


have not been established.
Contraindications:

 XENICAL is contraindicated in patients with


chronic malabsorption syndrome or
cholestasis, and in patients with known
hypersensitivity to XENICAL or to any
component of this product.
Side effects:

 Adverse reactions to Xenical are largely


gastrointestinal in nature and related to the
prevention of the absorption of ingested fat.
 Commonly observed events are oily spotting,
flatus with discharge, fecal urgency, fatty/oily
stool, oily evacuation, increased defecation
and fecal incontinence. The incidence of
these increases the higher the fat content of
the diet
% of common adverse effects
Less frequent side effects:
So Xenical produces a

Complete disturbance of
the life style of the patient
Defecation urge
Toilet Shifted life style
Bad smell in the toilet for
long periods
Excessive Flatulence
with bad smell
Oil & stool spots
See the difference with
Chitocal

 No Oily spotting.
 No Fecal incontinence or urge.
 No Flatulence (Actually decreases it).
 No Fatty or oily stools.
 No alteration in stool odor.
 No alteration in defecation rate.
 No low fat diet
 Chitocal acts on both lipids & carbohydrates
Simply;

 Chitocal insures excellent quality of


life without affecting GIT functions.
 No low fat diet is needed.
 Chitocal acts on both lipids &
carbohydrates.
Chitocal out of competition

Competitors Competitors
… …
Chitoca
l
Non-Diet weight control

DBK pharma
Chitocal composition:

• 500mg Chitosan (VHD-very high density)


( The fat magnet)

• 100mg Ascorbic acid


( potentates Chitosan effect)

• 50mg Gymnema Sylvestre


(Gurmar or the sugar destroyer)
VHD Chitosan
• It is a natural aminopolysaccharide derived from
chitin deacetylation.
• Chitin is derived from the exoskeletons of
crustaceans like shrimps.

• it is indigestible & non–absorbable from the GIT.


• it is Highly lipophilic fiber
VHD - Chitosan
VHD - Chitosan

•It forms with lipids a polymer that will not be


absorbed & then will be excreted with stools.
•It can bind an average 10-12 folds of lipids of
its weight.
VHD - Chitosan
Mechanism of lipid trapping:
Chitosan has a dual mechanism for traping
lipids:
4. Magnet like effect.
5. Net like effect.
1. Magnet like effect.
Chitosan posses a strong positive charges in
its amino group (after the deacetylation
processes) so it is electrically attracted to the
negatively charged lipids to form a non-
absorbable polymer which will be excreted in
stools.
Chitosan fatty acid complex
2. Net like effect.

Chitosan polymer has a net like structure which has the


capability to trap emulsified lipids into its network
structure preventing there absorption in the GIT.
Trapped lipids

Chitosan gel

Chitosan net like mechanism of lipid trapping


VHD - Chitosan
• Increases fat excretion by average 72%
• Reduction of fat absorption  less body fat
• Decreases serum cholesterol level.(LDL)
• Decreases serum TG level.
• Increases serum HDL.
Chitocal contains a very high density Chitosan to
excrete more than 72% of the fat content in diet

% of fat excretion

100
80
60
40
20
0
Low density Xenical 360mg/ high density
chitosan day Chitosan
1000mg/day 1000mg/day
Ascorbic Acid

• Vitamin C reduces the viscosity of chitosan and


improves its ability to mix with fat in the stomach.
Scientists also believe it may increase the oil
holding capacity of the chitosan gel.
•In addition, vitamin C (AsA) also improves the
ability of chitosan to successfully carry fat through
the intestine

. "Mechanism for the inhibition of fat digestion by chitosan and for the synergistic effect of
ascorbate." Biosci Biotechnol Biochem, 1995 May; Vol: 59; Number: 5; Page: 786-90;
Ascorbic Acid

• The mechanical properties of the chitosan gels indicate


that the chitosan-AsA-HCL gel was more flexible than the
chitosan-HCL gel, although the hardness of the latter was
higher than that of the former. In other words, the chitosan-
HCL gel exhibited brittle fracture like breaking biscuits, while
the chitosan-AsA-HCL gel exhibited ductal fracture like that
of cheese.
•It is reasonable to assume that the more brittle the chitosan
gel, the greater the release of alimentary fat from chitosan
due to breakage of the gel while being transported in the
intestines"
Gymnema Sylvestre

• It is an Indian herbal.
• It is called The “ GURMAR” i.e. The sugar destroyer.
Gymnema Sylvestre

• It is an Indian herbal.
• It is called The “ GURMAR” i.e. The sugar destroyer.
• it competitively inhibits glucose absorption at its
receptors in the GIT
• Decreasing serum glucose  increase glycolysis 
increase gluconeogenesis  Decrease body fat content
 weight loss.
Gymnema Sylv. Do Blair like action

Complex carbohydrates are simplified to be simple


sugar (glucose)

Gymnema silvestre acts as a Competitive


inhibitor to glucose at its receptor site

Thus more than 50% of the glucose & carbohydrates


will be excreted in stools
Gymnema Sylvestre’s action
Competitive inhibitor to glucose at its receptor site

GL GL
GL

GL GL GL
Intestinal GL
wall GS GL
GS GL

GS
GS
GL GL
GL
GL
GS GL
Glucos
e
GL
GS
recepto GL
Blood stream r

To stools

GL
GL Glucose GS Gymnema sylvestre
Chitocal (Gymnema Sylvestre) & D.M.

• It is effective for type I & II diabetes.


• In Type I D.M. it decreases the fasting blood glucose &
decreases insulin requirement.
• In Type II D.M. it decreases the fasting blood glucose &
decreases oral hypoglycemic doses
• In type II D.M.; 20% of patients may be able to
discontinue there medication & having a controlled
blood glucose levels.
Chitocal (Gymnema Sylvestre) & D.M.

• Diabetic patients on oral hypoglycemics or insulin


therapy may suffer from mild to moderate
hypoglycaemia, so they have to:
1. take a spoon of sugar it this attack occurs.
2. Decrease the dose of there hypoglycemic drugs
after consulting their physician.
• Thus Chitocal can decrease Fat & glucose
absorption from the GIT.

• Thus Chitocal can washes the excess


calories from our diet without having a VLCD.

 simple & smooth weight loss.


Simple Dose:
• Take Chitocal capsules ¼ hr. before meal.
• Calculate the no. of capsules according to
fat & sugar content in the diet.
• Example: for Breakfast & dinner take 1
cap. ¼ hr before meal. For regular lunch
take 2-3 capsule ¼ hr. before meal.
• As you Eat more calories Take
more capsules.

• Don’t be afraid from the extra


calories.

• Chitocal will wash them


outside the body  weight loss
Safety margin:

• Chitocal Has a great safety margin.


• LD50 for chitosan is 1.33 gm/day/kg
body weight.

• for 70 Kg weight person the LD50 = 93


gm = 186 capsule.

• That means impossible toxicity.


Side effects:
The side effects of Chitocal are referred
to its dietary calories washing effects &
due to its increase in fat excretion
3. Stool softness.
4. Exhaustion & fatigue.
5. Altered sugar taste
Conclusion:
• Chitocal washes out extra calories from our
diet  weight loss.
• Chitocal Promotes smooth weight loss.
• Chitocal decreases hypercholestreamia.
• Chitocal controls blood glucose levels.
• Chitocal decreases the risk factors for CVD,
D.M., osteoarthritis, …….
• With Chitocal you will love
your Mirror image, your clothes &
activities.
• Chitocal Improves your quality
of life.
Chitoca
st
l
1 Product acting on both
lipids & carbohydrates
Chitocal
Please God… If I can’t be
Slim

Make all other people


fatty
With Chitocal You can:
- Eat what you want.
- Lose the weight as you want.
Thank you
Contact ME:
Dr_waelsaid@yahoo.com

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