Appetite suppressants have been available as weight-reducing
aids for over 50 years. The first discovered was
amphetamine, which was potent, but possessed undesirable side effects (it is a stimulant and elevates blood pressure). Subsequently, a variety of appetite drugs was developed, all structurally related to
amphetamine, but mostly lacking unwanted side effects. Until recently,
fenfluramine (FEN) was the most widely used; presently,
sibutramine is the most commonly used
appetite suppressant. While these
appetite suppressants are effective at reducing hunger and food intake when given as a single dose or for short periods of time, their effectiveness diminishes when administered chronically. The
biological mechanisms underlying this tolerance have not been carefully studied, but many possibilities have been identified, including the down-regulation in brain of
neurotransmitter receptors that might mediate the action of these drugs and adaptive responses of the appetite control circuitry in brain. To date, however, few studies have examined these possibilities in any detail. This article focuses on the question of why
appetite suppressants lose efficacy, when given chronically, because this issue is important to the development of the next generation of
appetite suppressants. Chronic efficacy should be an issue studied relatively early in the
drug development process. This issue is of particular relevance, since
obesity treatment is now recognized as a long-term, not a short-term, process. If
appetite suppressants are to become a more important tool in
obesity treatment, agents that do not lose efficacy when administered for extended periods of time must be identified.