Generic Meridia Sibutramine - Online order at low price

MERIDIA® (sibutramine hydrochloride monohydrate) is an orally administered agent for the treatment of obesity.

Generic Meridia is indicated for the management of obesity, including weight loss and maintenance of weight loss, and should be used in conjunction with a reduced calorie diet. Generic Meridia is recommended for obese patients with an initial body mass index > 30 kg/m2 or > 27 kg/m2 in the presence of other risk factors (e.g. hypertension, diabetes, dyslipidemia). Body mass index is calculated by taking the patient`s weight, in kg, and dividing by the square of the height of the patient, in metres.

Dosage and administration.

The recommended starting dose of Generic Meridia is 10 mg 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. Doses above 15 mg daily are not recommended. The 5 mg dose should be reserved for patients who do not tolerate the 10 mg dose. Blood pressure and heart rate changes should be taken into account when making decisions regarding dose titration.

Contraindications
Hypersensitivity to sibutramine
Patients receiving monoamine oxidase inhibitors
Patients taking other centrally acting appetite suppressant drugs
Anorexia nervosa.

Warnings and precautions

DRUG INTERACTIONS
CNS active drugs: Sibutramine should not be used concomitantly with monoamine oxidase inhibitors (MAOI) and serotonergic drugs (selective serotonin reuptake inhibitors) since rare, but serious, constellation of symptoms termed ‘serotonin syndrome’ have been reported. At least two weeks should elapse between discontinuation of an MAOI and initiation of treatment with sibutramine. Similarly, at least two weeks should elapse between discontinuation of sibutramine and an MAOI.

Drugs that may raise blood pressure and/or heart rate: Concomitant use of sibutramine and other agents that may raise blood pressure or heart rate (e.g. certain decongestants, cough, cold and allergy medications that contain agents such as phenylpropanolamine, ephedrine or pseudoephedrine) have not been evaluated. Caution should be used when prescribing sibutramine to patients who use these medications.

Drugs that inhibit cytochrome P450 (3A4) metabolism: In vitro studies have shown that ketoconazole, erythromycin and cimetidine inhibit the cytochrome P450 (3A4) mediated metabolism of sibutramine but the magnitude of such an interaction appears to be small and not of clinical significance.

Alcohol: The concomitant use of sibutramine and excess alcohol is not recommended.

BLOOD PRESSURE AND PULSE

Sibutramine substantially increases blood pressure in some patients. Hence regular monitoring of blood pressure is required when prescribing sibutramine. For patients who experience a sustained increase in blood pressure or pulse rate while receiving sibutramine, either dose reduction or discontinuation should be considered. Sibutramine should be given with caution to those patients with a history of hypertension and should not be given to patients with uncontrolled or poorly controlled hypertension.

CONCOMITANT CARDIOVASCULAR DISEASE
Treatment with sibutramine has been associated with increases in heart rate and/or blood pressure. Therefore, sibutramine should not be used in patients with a history of coronary artery disease, congestive heart failure, arrhythmias or stroke.

GLAUCOMA
Because sibutramine can cause mydriasis, it should be used with caution in patients with narrow angle glaucoma.

PULMONARY HYPERTENSION
Certain centrally-acting weight loss agents that cause release of serotonin from nerve terminals have been associated with pulmonary hypertension (PPH), a rare but lethal disease. In pre-marketing clinical studies, no cases of PPH have been reported with sibutramine. Because of the low incidence of this disease in the underlying population, however, it is not known whether or not sibutramine may cause this disease.

SEIZURES
During premarketing testing, seizures were reported in 0.1% of sibutramine-treated patients. Sibutramine should be used cautiously in patients with a history of seizures. It should be discontinued in any patient who develops seizures.

GALLSTONES
Weight loss can precipitate or exacerbate gallstone formation.

RENAL/HEPATIC DYSFUNCTION
Patients with severe renal impairment or severe hepatic dysfunction have not been systematically studied; sibutramine should therefore not be used in such patients.

INTERFERENCE WITH COGNITIVE AND MOTOR PERFORMANCE
Although sibutramine did not affect psychomotor or cognitive performance in healthy volunteers, any CNS active drug has the potential to impair judgment, thinking or motor skills.

MISCELLANEOUS
Organic causes of obesity (e.g. untreated hypothyroidism) should be excluded before prescribing sibutramine.

PREGNANCY
There are no adequate and well controlled studies with sibutramine in pregnant women. The use of sibutramine during pregnancy is not recommended Women of child-bearing potential should employ adequate contraception while taking sibutramine. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy.

NURSING MOTHERS
It is not known whether sibutramine or its metabolites are excreted in human milk. Sibutramine is not recommended for use in nursing mothers. Patients should be advised to notify their physician if they are breast feeding.

PEDIATRIC USE
The safety and efficacy of sibutramine in pediatric patients under 16 years of age have not been established.

Meridia Side effects
Sibutramine is generally well tolerated. Dry mouth, anorexia, insomnia and constipation are the commonly observed side effects. Convulsions have been reported in patients who had potentially predisposing factors for seizures. Ecchymosis/bleeding have been observed due to its possible effects on platelet function as a result of its effect on serotonin uptake. Other side effects observed are diarrhea, flatulence, gastroenteritis, peripheral oedema, arthritis, agitation, hypertonia, bronchitis, pruritis and menstrual disorders.

CLINICAL STUDIES

Observational epidemiologic studies have established a relationship between obesity and the risks for cardiovascular disease, non-insulin dependent diabetes mellitus (NIDDM), certain forms of cancer, gallstones, certain respiratory disorders, and an increase in overall mortality. These studies suggest that weight loss, if maintained, may produce health benefits for some patients with chronic obesity who may also be at risk for other diseases.

The long-term effects of MERIDIA on the morbidity and mortality associated with obesity have not been established. Weight loss was examined in 11 double-blind, placebo-controlled obesity trials with study durations of 12 to 52 weeks and doses ranging from 1 to 30 mg once daily. Weight was significantly reduced in a dose-related manner in sibutramine-treated patients compared to placebo over the dose range of 5 to 20 mg once daily. In two 12-month studies, maximal weight loss was achieved by 6 months and statistically significant weight loss was maintained over 12 months. The amount of placebo-subtracted weight loss achieved on MERIDIA was consistent across studies.

Analysis of the data in three long-term (>/=6 months) obesity trials indicates that patients who lose at least 4 pounds in the first 4 weeks of therapy with a given dose of MERIDIA are most likely to achieve significant long-term weight loss on that dose of MERIDIA. Approximately 60% of such patients went on to achieve a placebo-subtracted weight loss of >/=5% of their initial body weight by month 6. Conversely, of those patients on a given dose of MERIDIA who did not lose at least 4 pounds in the first 4 weeks of therapy, approximately 80% did not go on to achieve a placebo-subtracted weight loss of >/=5% of their initial body weight on that dose by month 6.

Significant dose-related reductions in waist circumference, an indicator of intra-abdominal fat, have also been observed over 6 and 12 months in placebo-controlled clinical trials. In a 12-week placebo-controlled study of non-insulin dependent diabetes mellitus patients randomized to placebo or 15 mg per day of MERIDIA, Dual Energy X-Ray Absorptiometry (DEXA) assessment of changes in body composition showed that total body fat mass decreased by 1.8 kg in the MERIDIA group versus 0.2 kg in the placebo group (p<0.001). Similarly, truncal (android) fat mass decreased by 0.6 kg in the MERIDIA group versus 0.1 kg in the placebo group (p<0.01). The changes in lean mass, fasting blood sugar, and HbA were not statistically different between the two groups.

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