The introduction of sibutramine has brought a new therapeutic option for the management of many overweight and obese patients. To date it has been used by more than eight million patients in over 70 countries. As part of a comprehensive programme that includes diet and lifestyle guidance, the additive effect of sibutramine (10 or 15 mg/day) facilitates patients to achieve and sustain greater weight loss. Overall weight loss is typically 5—10% of starting body weight, and this is almost entirely due to loss of excess adipose tissue. Commensurate with this level of weight loss, benefits have been noted in comorbidities such as insulin resistance, type 2 diabetes and dyslipidaemia. Sibutramine is a serotonin-noradrenaline (norepinephrine) re-uptake inhibitor which acts centrally to induce satiety and maintain thermogenic expenditure. The main side effects are increased heart rate and blood pressure which are generally small, but require frequent checks.
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