Current pharmacotherapy for weight loss: a review and implications for plastic surgeons

Many patients who present for plastic surgery take weight loss drugs that can interact with anesthetics or have other adverse effects.

We examine the implications that pharmacotherapy for weight loss might have for plastic surgery.

The mechanisms of action, drug interactions, and possible adverse effects of sibutramine (Meridia) and orlistat (Xenical), the two medications that have been approved for weight loss by the US Food and Drug Administration, are reviewed. Similarly, the effects of both over-the-counter weight loss medications containing ephedrine and caffeine and serotonin re-uptake inhibitors that are used to augment weight loss are examined. We also report on the status of pharmacologic research on weight reduction agents under development, including leptin, neuropeptide Y, and uncoupling protein UCP-5.

The best way to avoid any untoward effects of weight loss medications in combination with surgery is to determine whether patients are taking such medications, counsel them concerning possible complications, and insist on discontinuation of pharmacotherapy for weight loss beginning 2 weeks before surgery.