THE SKINNY: This prescription weight-loss drug acts on the brain's appetite-control center to make you feel fuller faster so you'll likely eat less, says Madelyn Fernstrom, Ph.D., of the Weight Management Center at the University of Pittsburgh Medical Center. It works by altering levels of serotonin and norepinephrine, two chemicals that help regulate satiety. People on sibutramine lost about 10 pounds more in a year than those taking a placebo, according to a study review.
THE RISKS: Meridia can raise blood pressure, increasing the risk of heart attack or stroke. In fact, it was temporarily banned in Italy five years ago, after 50 adverse reactions. And in 2002, the nonprofit group Public Citizen petitioned the FDA to ban it in the United States, citing evidence that Meridia was associated with 29 deaths and hundreds of reactions such as rapid heart rate, high blood pressure, and heart palpitations. The FDA stated that while it wouldn't ban the drug, it would monitor the pill's safety. (Abbott, Meridia's manufacturer, maintains that the drug is safe, based on clinical trials of more than 12,000 patients.)
IS THIS PILL FOR YOU? Meridia is approved for obese people (having a BMI of 30 or higher) and those who are overweight (with a BMI of 27 or higher) who also have other health risk factors such as diabetes or high cholesterol. (Meridia may help these conditions by facilitating weight loss.) "It's most effective in people who complain of never feeling full," says Fernstrom. "It takes away that bottomless-pit feeling." Since Meridia may increase blood pressure, some doctors prescribe it to those under the age of 40 with no other heart disease risk factors. "I'll put patients on Meridia but I'll check their blood pressure once or twice a month," says Michael Steelman, M.D., a spokesperson for the ASBP. "I also often lower the dose initially to reduce side effects."
The drug isn't cheap it's about $120 per month. And Meridia, like other diet drugs, often isn't covered by insurance. As a result, some doctors prescribe antidepressants such as Effexor, Cymbalta, or Wellbutrin instead, since they also work by altering brain chemical levels and are more likely to be covered by insurance. But antidepressants might not have the exact same effect: "They help ease any depression that may cause overeating, but they won't necessarily control cravings," says Fernstrom.