STILL NO MAGIC PILLS FOR WEIGHT LOSS

For people who look to diet pills for a cure to their obesity, the pill pool just got thinner. With the recent call by the FDA for the voluntary withdrawal of fenfluramine and dexfenfluramine, the drug battle against obesity has suffered a setback.

The Food and Drug Administration asked for the voluntary withdrawal based on a July 8, 1997, report from the Mayo Clinic which reported 24 patients developed heart valve disease after taking fen-phen. Since the initial report, the FDA received additional information that raised more concern, which prompted the Sept. 15 voluntary withdrawal.

The drugs are sold under the brand names Podimin (which is fenfluramine and contains dexfenfluramine and levofenfluramine) and Redux (which contains only dexfenfluramine).

Another weight loss drug, phentermine, is not being withdrawn from the market because no cases of heart valve disease have been reported yet in cases where phentermine was used alone.

Carroll Snead, a Cape Girardeau ppharmacist, said that there are still a few alternative diet pills on the market, such as Fastin, Tenuate and others, but he said that all appetite suppressants have been associated with side effects.

But, he added, when it comes to losing weight, some people will put up with a lot of side effects.

Snead also said that few of his customers were taking the diet pills.

"We don't get that many prescriptions for it," Snead said.

Snead wasn't aware of any local doctors who prescribed the pills. The prescriptions for Podimin and Redux he did fill were from out-of-town physicians.

He added that none of the diet pills are effective unless the patient also cuts their food intake.

Steve Horst, a Jackson pharmacist, said he doesn't have many customers who used the drugs, but the drug was popular in other areas in the country.

"There is no magic pill. Eat less and exercise more," Horst said.

Tom Sparkman, M.D., said he has not prescribed the drug but he said he could see a temptation for other practitioners to prescribe cousins to these drugs in the future.

"My only concern is that if we've documented a cause-effect relationship between these amphetamine drugs and heart problems then we need to think twice about using these other drugs," Sparkman said.

"Our face is really red on this," he added.

But for obese patients, Sparkman said that physicians still recognize the basic premise of losing weight is diet and exercise.

The FDA advised people taking the diet pills to consult their physicians to see what the appropriate follow-up will be and if an echocardiogram is needed.

Sparkman said most doctors would likely wait until symptoms are present before they would seek an echocardiogram to find heart valve disease.

He said that he didn't feel it would be a very good spending of the health care dollar for everyone who took the drugs to go out and have their hearts checked for valve disease unless symptoms are present. He added that in many people, it would be too early to tell at this point anyway.

Sparkman also said that using filler foods are another good way to combat obesity. Apples, oranges, cauliflower, bread sticks, non-buttered popcorn, pineapples, soup, strawberries and plain low-fat yogurt are some of the good filler foods to help in weight loss that Sparkman advises his patients to eat.

People who are currently using the drugs have been advised by the FDA to stop using them. The advice doesn't apply to the use of phentermine alone.

Herbal fen-phen does not contain fenfluramine, dexfenfluramine or phentermine. It usually contains a combination of ephedra and caffeine and possibly other herbal ingredients. The FDA hasn't reviewed the herbal products for safety because the FDA doesn't have the responsibility to review certain dietary supplements.