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 …

Non-Diet weight control

Chitoca l

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 nonabsorbable 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 chitosan 1000mg/day Xenical 360mg/ day high density Chitosan 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 chitosanHCL 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

Intestinal wall

GL
GS

GL
GS

GL GL
GS

GL

GL
GS

GL GL

GL Glucos e recepto r

Blood stream

GS

GL

To stools
GL

GL

Glucose

GS

Gymnema sylvestre

GL

GS

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 l
st

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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