Mazindol Fenfluramine

Qosely related chemically to amphetamine are the so-called appetite suppressants or anorexiants, such as fenfluramine, mazindole, and sibutra-mine. These may also cause dependence and their therapeutic value and safety are questionable. 

Anorectic drugs, appetite suppressants, are also found in diet pills such as fenfluramine (or fen-phen), phenter-mine, diethylproprion, and mazindol. Perhaps the most hazardous ingredient commonly found in diet pills until a few years ago was ephedrine. Ephedrine is more commonly known as one of the precursor chemicals needed to manufacture methamphetamine. 

There is also an isolated case of cardiomyopathy attributed to the use of fenfluramine with mazindoL Before the withdrawal of the drug from the market, the manufacturer of fenfluramine recommended that concurrent use with other centrally acting anorectics should be avoided. ... 

Gillis D, Wengrower D, Witztum E, Leitersdorf E. Fenfluramine and mazindol acute reversible cardiomyopathy associaXedwiihthek use. IntJ Psychiatry Med( 9S5) 15, 197-200. 

Simultaneous acetylcodeine, amphetamine, benzphetamine, benzylmorphine, bromo-STP, buprenorphine, chlorphentermine, codeine, codeine-N-oxide, dextromoramide, dextropro-poxyphene, diamorphine, diethylpropion, dihydrocodeine, dihydromorphine, dimethylam-phetamine, dipipanone, ephedrine, epinephrine, ethoheptazine, ethylmorphine, etorphine, fencamfamin, fenfluramine, fentanyl, hydrocodone, 4-hydroxyamphetamine, levorphanol, mazindol, meperidine, mephentermine, mescaline, methadone, methamphetamine, meth-ylenediojQramphetamine, methylephedrine, monoacetylmorphine, morphine, morphine-3-glucuronide, morphine-N-oxide, naloxone, norcodeine, norlevorphanol, normetanephrine, normethadone, normorphine, norpethidine, norpseudoephedrine, noscapine, o codone, papaverine, pemoline, pentazocine, 2-phenethylamine, phenoperidine, phentermine, phenylephrine, phenylpropanolamine, pholcodeine, pipradol, piritramide, prolintane, pseudoephedrine, STP, thebacon, thebaine, trimethoxyamphetamine, tyramine... 

Fig. 4. Effects of various agents on resting metabolic rate (RMR) in rats. noradrenaline (O) dexamphetamine ( ) mazindol (a) ciclazindol ( ) and fenfluramine (O). Adapted from Rothwell et al.y 1981.

A number of compounds act either to suppress the activity of the hunger centre in the hypothalamus or to stimulate the satiety centre. Sometimes this is an undesirable side-effect of drugs used to treat disease and can contribute to the undernutrition seen in chronically ill people (section 8.4). As an aid to weight reduction, especially in people who find it difficult to control their food intake, drugs that suppress appetite can be useful. Three compounds are in relatively widespread use as appetite suppressants fenfluramine (and more recently the D-isomer, dexfenfluramine), diethylpropion and mazindol. The combination of phentermine and fenfluramine was withdrawn in the 1990s, after a number of reports associating it with cardiac damage. 

The main thnist of interest represented in the literature of the past year has been in the field of the assessment of the newer anorectic agents and in particular the use of doubleblind techniques to carry out such studies. The present review will devote particular attention to three of these agents diethylpro-pion, fenfluramine and mazindol. 

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