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Rethinking Redux

'Tis the season of post holiday guilt. And with it, the resolution to lose 15 pounds by May, just in time for your high school reunion.

You've heard about Redux, the diet pill available by prescription that was recently approved by the Food and Drug Administration (FDA), and wonder if it's the answer to your weight problems.

Redux, trade name for the appetite suppressant dexfenfluramine, is definitely hot. During its first five months on the market, more than 1.2 million prescriptions were written for the drug. That's a lot of prescriptions for a drug we know relatively little about. In many respects, by approving the drug at this point in time, the FDA approved a giant "field study" to evaluate the efficacy of the drug and got all its subjects to pay for the privilege of being in the study.

Why the large interest in Redux? Part of the craze is due to our obsession with quick weight-loss fixes. Part is due to the fact it's the first fat-fighting prescription drug to be approved by the FDA in more than 20 years. But part of the interest is being driven by a highly aggressive marketing campaign that goes beyond the accepted audience for the drug, the morbidly obese, to those who want to lose a few pounds for cosmetic reasons.

According to the Wall Street Journal, Redux salesmen logged 140,000 doctor visits in the first three months the drug was available. Not only were obesity specialists contacted, but also family physicians, psychiatrists, cardiologists, internists, even gynecologists.

How will the great Redux field trial turn out? Only time will tell, but some of the early results are not too promising. Dexfenfluramine and its sister drug, fenfluramine, act as appetite suppressants by affecting serotonin in two ways: First, by allowing serotonin to stay "in play" longer, and second, by triggering the release of additional serotonin. Not only do they appear to work only while you're on the drug, but they also can cause a number of side effects.

Common side effects include diarrhea, dry mouth, tiredness and sleep disturbances. Some of these may decrease with time, but some may not. There also is evidence some people may experience neurotoxicity--irreversible brain damage--as a result of taking the drug.

The most alarming potential side effect, though, is the increased risk for primary pulmonary hypertension (PPH). This rare but serious disorder kills half its victims in less than four years. Initial data showed use of Redux for three months or longer increased one's risk of PPH from two in a million to 18 in a million (a nine-fold increase). That estimate now has been increased to 46 per million (a 23-fold increase).

Weight loss is big business and obesity is a huge health problem with its own set of side effects, some of which are life threatening. For those with significant weight problems, Redux may prove useful as part of a comprehensive health program that includes lifestyle changes that promote a healthful diet and plenty of activity. However, for the person with just a few pounds to lose, lifestyle changes without drugs are the better way to go.

For more information, contact your local Colorado State University Cooperative Extension office.