Rimonabant Orlistat

Keywords Diabetes, Pharmacotherapy, Orlistat, Siblitramine, Rimonabant, Weightless... 

Padwal RS, Majumdar SR Drug treatments for obesity orlistat, sibutramine, and rimonabant. Lancet 369 11-11, 2007. 

Ketoconazole doubled the AUC of rimonabant, and other potent CYP3A4 inhibitors are also expected to raise rimonabant levels. Potent CYP3A4 inducers are expected to lower rimonabant levels. Due to a lack of information the manufacturers suggest that rimonabant should not be taken with antidepressants. Rimonabant does not appear to affect the levels of oral contraceptives, di-goxin, midazolam or warfarin, and alcohol, lorazepam, and orlistat do not appear to alter rimonabant levels. 

Systematic reviews In a systematic review of 28 randomized placebo-controUed trials lasting 12-24 months in adults using hcensed doses of orlistat (16 trials), sibutramine (7 trials), and rimonabant (5 trials), the risk ratios (RRs) for withdrawal because of adverse events were significantly increased for rimonabant (2.00 Cl = 1.66, 2.41) and orlistat (1.59 1.21, 2.08), but not sibutramine (0.98 0.68, 1.41) [112 ]. Compared with placebo, the risk difference for rimonabant was 7% (NNTh 14) and for orhstat 3% (NNTh 39). The most common adverse events that led to withdrawal were gastrointestinal with orhstat (40%) and psychiatric with rimonabant (47%). 

Johansson K, Neovius K, DeSantis SM, Rossner S, Neovius M. Discontinuation due to adverse events in randomized trials of orlistat, sibutramine and rimonabant a meta-analysis. Obes Rev 2009 10(5) 564—75. 

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