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with James Beckerman, MD, FACC

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Monday, February 27, 2012

Is Qnexa the Next Statin?

By James Beckerman, MD, FACC

New Prescription

You are sitting in your doctor’s office, and after reviewing your laboratory tests, you hear what hundreds of millions have already been told:

“I think you should take a statin.”

So what’s your response? While some people are open to taking a cholesterol medication, others are not. So when I recommend a statin, I explain why. I describe the data that supports the use of statins to reduce the risk of heart attacks and strokes in higher risk individuals. I discuss what I perceive to be a benefit in lower risk people with significantly abnormal lipids. I mention the anti-inflammatory, anti-oxidant, and anti-clotting characteristics of statins which likely contribute to their benefit above and beyond their impact on your cholesterol levels. And despite some valid concerns regarding side effects, I also note that statins are likely the best studied medication in all of pharmaco-history. In the end, some take the prescription home, and others decide,

“I think I’ll work harder on diet and exercise.”

So fast forward to a world where Qnexa has been approved by the Food and Drug Administration — its expert panel gave it a thumbs up last week, so keep your eyes open for the television commercials any day now. Qnexa is a combination of phentermine and topiramate — an amphetamine and an anti-seizure medication with potential risks including elevated heart rate, fatigue, nausea, and increased risk of cleft deformities in children of pregnant women taking the drug. It was previously rejected because of concerns about these side effects and unknown longer term effects. But it will likely be approved because it is associated with loss of about 10% of total body weight. As with other obesity medications, the weight comes back if you stop the drug.

So there you sit in your doctor’s office, and after reviewing your weight and cardiovascular risk factors, you may soon hear what hundreds of millions will likely be told:

“I think you should take Qnexa.”

So what’s your response? Will you express concern about a medical therapy that was previously rejected because of safety concerns just two years ago? Will you wait for long-term data about its impact on blood pressure and stroke? Will you ask how it works, and wonder why a seizure medication is being used to help people lose weight? Will you take the prescription home, or will you decide,

“I think I’ll work harder on diet and exercise.”

I’ll be interested in your reaction. But if you go for the Qnexa, there might be a prescription for a statin waiting for you at the pharmacy too…

Posted by: James Beckerman, MD, FACC at 2:52 pm

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