Diseases Series Topics No 1. Obesity

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Diseases Series Topics No 1. Obesity

Obesity management / ওজন কমানো:

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জীবন ধারা পরিবর্তন ও

খাদ্যাভাস পরিবর্তনের পরই আসে ঔষধের কথা।

ওজন কমানোর ঔষধ কি আছে?

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হ্যাঁ, আছে। approved and available আছে ২ টি।

১) orlistat: ১২০ mg করে দিনে ৩ বার ভরা পেটে খেতে হয়। অনেকে ঔষধটি সহ্য করতে পারেনা এর পার্শ প্রতিক্রিয়ার জন্য । কারণ এতে ঘন ঘন তৈলাক্ত পায়খানা হয়, পায়খানা এমনিতেই বের হয়ে কাপড় নষ্ট হয়ে যেতে পারে, পেটের ভেতর শব্দ হয়।

Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

1+0+1 AM.

Indications of Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

Adults: Olistat is indicated in conjunction with a mildly hypocaloric diet for the treatment of obese patients with a body mass index (BMI)>30 kg/m² and overweight patients (BMI >28 kg/m² ) with associated risk factors such as type II diabetes, hyperlipidemia and hypertension. Treatment with Olistat should be discontinued after 12 weeks in patients who have not lost at least 5% of their body weight as measured at the start of drug therapy.

Adolescents (12 years & older): Obese adolescents should be treated with Olistat only if an adequate reduction of body weight cannot be achieved by means of diet & increased physical activity. Treatment with Olistat should be considered in particular if complications of obesity are present.

Pharmacology of Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

Orlistat is a potent, specific and long-acting lipase inhibitor. It exerts its therapeutic activity in the lumen of the stomach and upper small intestine by forming a covalent bond with the active serine site of gastric and pancreatic lipases. The inactivated enzyme is thus rendered unable to hydrolyze dietary fats in the form of triglycerides into absorbable free fatty acids and monoglycerides. As undigested triglycerides can not be absorbed, a caloric deficit arises which has a positive effect on weight control. Systemic absorption of orlistat is therefore not needed for the activity. At the recommended therapeutic dose of 120 mg three times a day, orlistat inhibit dietary fat absorption by approximately 30%.

Dosage & Administration of Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

The recommended dose of Orlistat is one 120 mg capsule to be taken immediately before, during or up to one hour after each main meal. If a meal is missed or contains no fat the dose of Orlistat should be omitted. Doses of Orlistat above 120 mg three times daily have not been shown to provide additional benefits. The effect of Orlistat results in an increase in fecal fat 24-48 hours after dosing. Upon discontinuation of therapy, fecal fat content usually returns to pretreatment levels within 48-72 hours.

The safety & efficacy of Orlistat were investigated in clinical studies lasting up to 4 years. The recommended dose of Orlistat for adolescents is as same as adults.

Special dosage instruction: The tolerability and efficacy of Orlistat have not been studied in elderly patients, or patients with hepatic and/ or renal impairments.

Interaction of Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

Reduction in cyclosporine plasma levels when Olistat was coadministered with cyclosporine. Olistat inhibited absorption of a vitamin E acetate supplement. The effect of Olistat on the absorption of supplemental vitamin D, vitamin A, and nutritionally-derived vitamin K is not known. Hypothyroidism has been reported in patients treated concomitantly with Olistat and levothyroxine. Patients treated concomitantly with Olistat and levothyroxine should be monitored for changes in thyroid function. Administer levothyroxine and Olistat at least 4 hours apart. Vitamin K absorption may be decreased with Olistat. Patients on chronic stable doses of warfarin who are prescribed Olistat should be monitored closely for changes in coagulation parameters. Convulsions have been reported in patients treated concomitantly with Olistat and antiepileptic drugs. Patients should be monitored for possible changes in the frequency and/or severity of convulsions.

Contraindications

Orlistat is contraindicated in patients with chronic malabsorption syndrome, in patients with cholestasis and in patients who are hypersensitive to orlistat or to any of the other ingredients of the capsules.

Side Effects of Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

Common: Undesirable effects of Olistat are largely gastrointestinal in nature. Common gastrointestinal side effects are oily spotting from the rectum, flatulence, fecal urgency, oily or fatty stool, abdominal discomfort etc.

Rare: Influenza, anxiety. headache, fatigue etc may rarely occur in some patients. Rare cases of hypersensitivity have been reported. Main clinical symptoms are pruritus, exanthema, urticaria, angioedema and anaphylaxis.

Pregnancy & Lactation

Pregnancy: Orlistat is Pregnancy Category X drug. Orlistat is contraindicated during pregnancy, because weight loss offers no potential benefit to a pregnant woman and may result in fetal harm. A minimum weight gain, and no weight loss, is currently recommended for all pregnant women, including those who are already overweight or obese, due to the obligatory weight gain that occurs in maternal tissues during pregnancy. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard of maternal weight loss to the fetus.

Lactation: It is not known if Orlistat is present in human milk. Caution should be exercised when Orlistat is administered to a nursing woman.

Precautions & Warnings

Organic causes of obesity (e.g. hypothyroidism) should be excluded before prescribing Olistat. Olistat and cyclosporine should not be coadministered. Cyclosporine should be taken at least 2 hours before or after Olistat in patients taking both drugs. Cyclosporine level should be measured and frequently monitored.

In clinical trial, the decrease in body weight with Olistat therapy was less in type II diabetic patients than in non-diabetic patients. Antidiabetic drug treatment should be closely monitored during Olistat therapy. Because of the improvement in glycemic control, the dose of oral antidiabetics or of insulin may need to be adjusted.

Patients should be advised to adhere to the dietary recommendations. The probability of occurrence of gastrointestinal side effects may increase when Olistat is taken with a fatty meal. The daily intake of fat should be distributed between three main meals. Patients should be strongly encouraged to take a multivitamin supplement that contains fat soluble vitamins to ensure adequate nutrition because Olistat has been shown to reduce the absorption of some fat soluble vitamins & beta-carotene. In addition, the levels of vitamin D & beta carotene may be low in obese patients compared with non-obese patients.

Overdose Effects

Single doses of 800 mg Olistat and multiple doses of up to 400 mg three times a day for 15 days have been studied in normal-weight and obese subjects without significant adverse findings. Should a significant overdose of Olistat occur, it is recommended that the patient be observed for 24 hours. Based on human and animal studies, systemic effects attributable to the lipase-inhibiting properties of Olistat should be rapidly reversible.

Therapeutic Class of Tablet:Olistat 120 mg (AS A Orlistat Appetite suppressant drugs/Anti-obesity drugs).

Appetite suppressant drugs/Anti-obesity drugs

২) সবচেয়ে কার্যকর ঔষধ : GLP1 RA. ( Semaglutide).এর সাহায্যে ওজন প্রায় ১০ কেজি পর্যন্ত কমানো সম্ভব।

তেমন বড় ধরনের পার্শ প্রতিক্রিয়া নেই।

তবে বমি বা বমি বমি লাগতে পারে।

এটি ইঞ্জেকশন আকারে থাকে। চামড়ার নীচে দিতে হয় সপ্তাহে একটি করে।

মুল সমস্যা দাম নিয়ে। একটি ইঞ্জেকশনের দাম ১৫০০/ টাকা। দিতে হয় অনেকদিন। আমাদের দেশে ইনসেপ্টা কোম্পানি নিয়ে এসেছে inj Fitaro নামে।

Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

7 days later …

Indications of Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

For Diabetes: Fitaro is indicated in-

An adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease

For Obesity: An adjunct to a reduced calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of:

30 kg/m² or greater (Obesity) or
27 kg/m² or greater (Overweight) in the presence of at least one weight-related comorbid condition (e.g. hypertension, type 2 diabetes mellitus or dyslipidemia).

Pharmacology Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

Semaglutide is a GLP-1 analogue with 94% sequence as same as to human GLP-1. Semaglutide acts as a GLP-1 receptor agonist that selectively binds to and activates the GLP-1 receptor. Semaglutide reduces blood glucose in a glucose dependent manner by stimulating insulin secretion and lowering glucagon secretion when blood glucose is high. The mechanism of blood glucose lowering also involves a minor delay in gastric emptying. During hypoglycemia, Semaglutide diminishes insulin secretion and does not impair glucagon secretion. Semaglutide reduces body weight and body fat mass by an overall reduced appetite.

Dosage & Administration Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

For Diabetes:

Semaglutide Tablet: Take Semaglutide at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces (118 ml) of plain water only.

Starter Dose: Start Semaglutide with 3 mg once daily for 30 days
Maintenance Dose: After 30 days on the 3 mg dose, increase the dose to 7 mg once daily
For Additional Glycemic Control: If additional glycemic control is needed after at least 30 days on the 7 mg dose, the dose can be increased to 14 mg once daily

Semaglutide injection: The starting dose is 0.25 mg Semaglutide once weekly. After 4 weeks the dose should be increased to 0.5 mg once weekly. After at least 4 weeks with a dose of 0.5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycemic control. Weekly doses higher than 1 mg are not recommended. Semaglutide is to be administered once weekly at any time of the day with or without meals. Semaglutide is to be injected subcutaneously in the abdomen, thigh or in upper arm. The injection site can be changed without dose adjustment. Semaglutide should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 3 days (>72 hours). After selecting a new dosing day, once weekly dosing should be continued.

Switching patients between Semaglutide injection and Semaglutide tablet-

Patients treated with once weekly Semaglutide injection 0.5 mg subcutaneous injection can be transitioned to Semaglutide 7 mg or 14 mg tablet. Patients can start Semaglutide tablet up to 7 days after their last injection of Semaglutide injection. There is no equivalent dose of Semaglutide tablet for Semaglutide injection 1 mg
Patients treated with Semaglutide 14 mg tablet daily can be transitioned to Semaglutide subcutaneous injection 0.5 mg once weekly. Patients can start Semaglutide injection the day after their last dose of Semaglutide tablet.

For Obesity: The starting dose is 0.25 mg Semaglutide once weekly for 4 weeks subcutaneously. If patients do not tolerate a dose during dose escalation, consider delaying dose escalation for 4 weeks. If patients do not tolerate the maintenance dose 2.4 mg, the dose can be temporarily decreased to 1.7 mg once weekly for maximum 4 weeks. After 4 weeks increase the dose to 2.4 mg. Weekly doses higher than 2.4 mg is not recommended. Semaglutide is to be administered once weekly at any time of the day with or without meals. Semaglutide is to be injected subcutaneously in the abdomen, thigh or in upper arm. The injection site can be changed without dose adjustment. Semaglutide should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2 days (>48 hours). After selecting a new dosing day, once weekly dosing should be continued.

Interaction Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

With medicine: Fitaro delays gastric emptying which may influence the absorption of other oral medications. Trials were conducted to study the potential effect of Fitaro on the absorption of oral medicinal products taken with Fitaro administered orally at steady state exposure.

With food & others: Concomitant intake of food reduces the exposure of Fitaro.

Contraindications

Semaxen is contraindicated in patients who are hypersensitive to Semaxen or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
Semaxen is contraindicated in patients who have a personal or family history of Medullary Thyroid Carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Semaxen should not be used during pregnancy or breastfeeding.

Side Effects

Common side effects: Vomiting, stomach upset or indigestion inflamed stomach, reflux or heartburn or GERD, stomach pain, bloating of the stomach, constipation, change in the way food or drink tastes, tiredness, less appetite, gas (flatulence), increase of pancreatic enzymes (such as lipase and amylase).

Rare side effects: Serious allergic reactions (anaphylactic reactions). You should seek immediate medical help and inform your doctor straight away if you get symptoms such as breathing problems, swelling of face and throat, wheezing, fast heartbeat, pale and cold skin, feeling dizzy or weak.

Pregnancy & Lactation

Pregnancy: The extent of exposure in pregnancy during clinical trials was very limited and there are no adequate and well controlled studies of Semaglutide in pregnant women. Therefore, Semaxen should not be used during pregnancy. If a patient wishes to become pregnant, or pregnancy occurs, Semaxen should be discontinued. Semaxen should be discontinued at least 2 months before a planned pregnancy due to the long half-life of Semaglutide.

Lactation: There are no data on the presence of Semaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. Because of the unknown potential for serious adverse reactions in the breastfed infant due to the possible accumulation of salcaprozate sodium (SNAC), an absorption enhancer in Semaxen, from breastfeeding and because there are alternative formulations of Semaglutide that can be used during lactation, advise patients that breastfeeding is not recommended during treatment with Semaxen. Discontinue Semaxen in women at least 2 months before a planned pregnancy due to the long washout period for Semaglutide.

Precautions & Warnings Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

Should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Patients should be advised to take precautions to avoid hypoglycemia while driving and using machines. Fitaro causes an increase in heart rate. Caution should be observed in patients who have cardiac conditions that might be worsened by an increase in heart rate, such as tachyarrhythmias. Patients treated with Fitaro in combination with an insulin secretagogue (e.g., sulfonylureas) or insulin may have an increased risk of hypoglycemia. The risk of hypoglycemia may be lowered by reducing the dose of the secretagogue or insulin when initiating treatment with Semaxen.

Use in Special Populations

Pediatric population: The safety and efficacy of Fitaro in children and adolescents below 18 years have not yet been established. No data are available.

Elderly: No dose adjustment is required based on age.

Renal impairment: No dose adjustment is required for patients with mild moderate or severe renal impairment. Fitaro is not recommended for use in patients with end-stage renal disease.

Hepatic impairment: No dose adjustment is required for patients with hepatic impairment. Caution should be exercised when treating these patients with Fitaro.

Overdose Effects

Overdose: Overdose of up to 4 mg in a single dose and up to 4 mg in a week have been reported in clinical trials. The most commonly reported adverse reaction was nausea. There is no specific antidote for overdose with Fitaro. In the event of overdose appropriate supportive treatment should be initiated according to the patients clinical sign and symptoms.

Dose adjustment: When Fitaro is added to existing metformin and/or thiazolidinedione therapy, the current dose of metformin and/or thiazolidinedione can be continued unchanged. When Fitaro is added to existing therapy of sulfonylurea or insulin, a reduction in the dose of sulfonylurea or insulin should be considered to reduce the risk of hypoglycemia. Self-monitoring in blood glucose is not needed in order to adjust the dose of Fitaro. Blood glucose self-monitoring is necessary to adjust the dose of sulfonylurea and insulin particularly when Fitaro is started and insulin is reduced.

Missed dose: If a dose is missed, it should be administered as soon as possible and within 5 days after the missed dose. If more than 5 days have passed, the missed dose should be skipped and the next dose should be administered on the regular scheduled day. In each case, patients can then resume their regular once weekly dosing schedule.

Therapeutic Class Inj:Fitaro 2.4mg/0.75ml (AS A ( Semaglutide) AS A GLP-1 receptor agonists).

GLP-1 receptor agonists

ঔষধটি ডায়াবেটিসের চিকিৎসায়ও ব্যবহার করা হয়। তবে তা অনেক কম ডোজে। ডায়াবেটিস নিয়ন্ত্রনের পাশাপাশি এটি ওজন কমায়, হৃদ রোগের ঝুঁকি কমায়।

ডায়াবেটিস না থাকলেও ওজন কমানোর এক কার্যকর ঔষধ এটি।

NB. Should be taken under the supervision of a graduate doctor.

Raiyyan Tahsan Date:-06-02-2025 Thursday Time:-11-19-45 Pm

Raiyyan Tahsan

Raiyyan Tahsan