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Introduction to Meridia

Meridia (sibutramine) is a prescription medication that was initially approved by the FDA in 1997 for weight loss and appetite suppression. It was developed by the pharmaceutical company Abbott Laboratories and marketed under the brand name Meridia. 

When it was first introduced, Meridia was viewed as an innovative new option for weight loss. At the time, the most common prescription weight loss drugs were appetite suppressants like phentermine. Meridia offered a different mechanism of action by targeting neurotransmitters linked to satiety and hunger signals.

Mechanism of Action

• Meridia works primarily by affecting neurotransmitters in the brain that regulate appetite and metabolism. It contains sibutramine, which inhibits the reuptake of the neurotransmitters norepinephrine, serotonin, and dopamine. This increases levels of these neurotransmitters, which enhances feelings of fullness and satiety. 
• The increased norepinephrine and dopamine stimulate thermogenesis, which is the generation of body heat by burning calories. This increases the basal metabolic rate, allowing the body to burn more calories even at rest. 
• Serotonin plays a key role in appetite regulation by signaling fullness and satisfaction after eating. By preventing serotonin reuptake, Meridia maintains higher serotonin levels which suppress appetite. This creates a feeling of fullness and reduces cravings.
• In summary, Meridia’s effects on these neurotransmitters combine to increase satiety, boost metabolism, and promote weight loss. It enables people to feel fuller faster, stay satisfied longer, and burn more calories.

Effectiveness for Weight Loss

1. Clinical trials have shown that Meridia can be an effective weight loss aid when combined with lifestyle changes. In several studies, participants taking Meridia lost significantly more weight than those taking a placebo.
2. One study published in JAMA followed over 800 overweight adults for 2 years. The group taking 10 mg of Meridia lost an average of 4.6 kg (10 pounds) more than the placebo group after 1 year, and maintained 2.4 kg (5.3 pounds) more weight loss after 2 years. 
3. Larger amounts of weight loss are seen when Meridia is combined with dietary changes, increased physical activity, and behavioral therapy. In a study where participants also received lifestyle modification counseling, those taking Meridia lost an average of 10.6 kg (23 pounds) compared to 6 kg (13 pounds) in the placebo group after 1 year.

Usage and Dosing

Meridia should be taken in the morning to avoid insomnia, as it can cause wakefulness if taken later in the day. It is not recommended to split doses. 

Meridia is contraindicated in patients with:

1. Uncontrolled hypertension
2. History of coronary artery disease, stroke, or peripheral vascular disease
3. Congestive heart failure
4. Arrhythmias 
5. History of anorexia or bulimia
6. Concurrent use of MAOIs
7. Pregnancy or breastfeeding
8. Allergies to sibutramine 

• Lifestyle Changes

Along with taking Meridia, making lifestyle changes can help maximize weight loss. The three main areas to focus on are diet, exercise, and behavior changes. 

• Diet

When taking Meridia, it’s important to follow a reduced-calorie diet. Aim for a daily calorie deficit of 500-1000 calories to promote steady weight loss. Focus on eating whole, unprocessed foods like fruits, vegetables, lean proteins, whole grains, and healthy fats. Limit sweets, fried foods, sugary beverages, and refined carbs. Meet with a dietitian to create a personalized meal plan. Tracking calories with an app can help stay on target. 

• Exercise 

Adding exercise while taking Meridia provides additional weight loss benefits. Aim for 150-300 minutes of moderate exercise per week, like brisk walking .Strength training 2-3 times a week also helps build muscle and boost metabolism. Start slow and gradually increase duration and intensity. Vary workouts to prevent boredom. Consider activities you enjoy and find an exercise buddy for motivation.  

• Behavior Changes

Making behavioral adjustments is key for long-term weight management. Keep a food and exercise journal to stay accountable. Get 7-8 hours of sleep nightly. Manage stress with yoga, meditation, or relaxation techniques. Join a support group to help make changes easier. Set small, achievable goals each week. Reward progress but don’t use food as a reward. Stay positive through setbacks. Changing habits takes time, so be patient and committed.

• Alternatives for Weight Loss

Other prescription and non-prescription options are available for those looking to lose weight. These alternatives should be considered before taking a medication like Meridia.

• Prescription Weight Loss Medications

Some other prescription weight loss drugs include phentermine, liraglutide, naltrexone-bupropion, and orlistat. These medications work in different ways, such as suppressing appetite, increasing feelings of fullness, or limiting fat absorption. Patients should consult with their doctor to see if these options may be appropriate for them.

• Over-the-Counter Supplements

Some non-prescription supplements claim to help with weight loss, such as garcinia cambogia, glucomannan, green tea extract, and conjugated linoleic acid. However, the evidence for these supplements aiding significant weight loss is generally lacking. Consulting with a doctor before trying supplements is recommended, as some can interact with medications or cause side effects. Overall, lifestyle changes tend to be safer and more effective.

Conclusions

Overall, Meridia was moderately effective for weight loss but had concerning safety issues. The average amount of weight loss on Meridia was around 5% greater than placebo over 1 year, which is lower than many other prescription weight loss drugs. While Meridia could help jump start a weight loss program, lifestyle changes in diet and exercise are required for long-term success. 

In summary, while Meridia led to modest weight loss, the cardiovascular risks outweighed benefits for most patients. Lifestyle changes and safer medical therapies should be pursued for obesity management instead of using Meridia.