Childhood Obesity in the United Kingdom 95given for the UK and European Union (EU) and the launch is anticipated in
2016.
Anti-Epileptic Medications
Topiramate
Topiramate acts as a gamma-aminobutyric acid (GABA) agonist and is an
established anti-epileptic drug. It is a carbonic anhydrase inhibitor that causes
glutamate antagonism, resulting in prolonged satiety. Following reports of
weight loss in patients taking Topiramate for treatment of epilepsy, Fox et al.
carried out a retrospective study of 28 patients, who received treatment with
Topiramate for 3 months, as part of a lifestyle modification programme [72].
The findings of this study indicate that the use of Topiramate, alongside life
style modification programmes, is associated with a clinically significant
reduction in BMI of 4-6% over 6 months. Importantly, Topiramate was well
tolerated, with only 2 patients experiencing paraesthesia. No other side effects
were reported [72]. Randomised controlled trials of Topiramate as a weight
loss drug in severely obese adults demonstrated weight loss from 4.8-9.7%
over a period of 24-64 weeks [73]. Side effects reported in adults were dose
dependent and included paraesthesia, dizziness and fatigue. The exact
mechanism by which Topiramate causes weight loss is still unclear. It has
been hypothesised that Topiramate may result in decreased stimulation of the
lateral hypothalamus, thereby reducing appetite. In children, Topiramate has
also been associated with decreased levels of the appetite stimulating
neurohormone Neuropeptide Y [72]. In children with epilepsy, treatment with
Topiramate has been shown to increase the protein hormone adiponectin,
which has an important role in metabolic regulations. However, use of
Topiramate has not yet been investigated in children with simple obesity [73,
74, 75, 76, 77, 78].
Centrally-Acting Noradrenergic Agents
Phentermine
Phentermine is a centrally acting noradrenergic agent, which reduces
appetite by activation of adrenergic and dopaminergic receptors. Phentermine
was first approved by the FDA for treatment of obese adults in 1959. Later, in
1973, a requirement for short-term treatment only was added (use for less than