In search of an ideal drug for safer treatment of obesity: The false promise of pseudoephedrine

Abstract

Obesity is a major public health problem worldwide. Only relatively few treatment options are, at present, available for the management of obese patients. Furthermore, treatment of obesity is affected by the widespread misuse of drugs and food supplements. Ephedra sinica is an old medicinal herb, commonly used in the treatment of respiratory tract diseases. Ephedra species contain several alkaloids, including pseudoephedrine, notably endowed with indirect sympathomimetic pharmacodynamic properties. The anorexigenic effect of pseudoephedrine is attributable primarily to the inhibition of neurons located in the hypothalamic paraventricular nucleus (PVN), mediating satiety stimuli. Pseudoephedrine influences lipolysis and thermogenesis through interaction with β3 adrenergic receptors and reduces fat accumulation through down-regulation of transcription factors related to lipogenesis. However, its use is associated with adverse events that involve to a large extent the cardiovascular and the central nervous system. Adverse events of pseudoephedrine also affect the eye, the intestine, and the skin, and, of relevance, sudden cardiovascular death related to dietary supplements containing Ephedra alkaloids has also been reported. In light of the limited availability of clinical data on pseudoephedrine in obesity, along with its significantly unbalanced risk/benefit profile, as well as of the psychophysical susceptibility of obese patients, it appears reasonable to preclude the prescription of pseudoephedrine in obese patients of any order and degree.

Alternativas Fitoterápicas No Controle Da Obesidade

“…A se caracteriza por uma infecção do sistema respiratório, causada pelo vírus SARS-coV-2, com sintomas como tosse, febre, dificuldades respiratórias que variam de leves a graves, podendo levar à morte (MUSCOGIURI et al, 2020).…”

“…Dentre os pacientes considerados de alto risco para o COVID-19 estão os idosos, os imunocomprometidos, os diabéticos, os pacientes com doenças cardíacas, pulmonares, hepáticas, renal e os pacientes obesos (IMC ≥ 40 kg/m 2 ) (MUSCOGIURI et al, 2020).…”

“…Entre seus alcalóides simpaticomiméticos, os principais são a efedrina e pseudoefedrina, classificados por alguns como anfetaminas puras (MUNAFO et al, 2021).…”

“…Os fitoterápicos são obtidos a partir de partes de plantas, como folhas, casca, frutos, rizomas, cálices, os quais são ricos em fitoquímicos e que auxiliam no tratamento da obesidade por diferentes mecanismos, como reduzindo a ingestão calórica, estimulando a termogênese, inibindo a diferenciação e diminuindo absorção de lipídios e por aumento da lipólise (KAZEMIPOOR et al, 2014). Os fitoterápicos com relatos de uso popular para o tratamento da obesidade incluem o chá verde (Camellia sinensis) (KUMAR, et al, 2020), o hibiscus (Hibiscus sabdariffa) (IZQUIERDO-VEJA, et al, 2020), o café verde (Coffea arabica) (PIMPLEV et al, 2020), a laranja amarga (Citrus aurantium) (SUNTAR et al, 2018), o sene (Senna alexandrina) (NAYAN et al, 2021), a efedra (Ephedra sinica) (MUNAFO et al, 2021), o gengibre (Zingiber officinale) (PARK et al, 2020).…”

Development of a Genus-Universal Nucleotide Signature for the Identification and Supervision of Ephedra-Containing Products

“…It can accelerate metabolism and fatigue remission in bodies and can alter the intestinal flora of obese people [ 7 ]. However, afterwards, high-dose and long-term use of Ephedra materials was reported to cause a series of adverse effects due to the content of ephedrine-type alkaloids [ 8 ]. Ephedrine alkaloids, such as l -ephedrine, d -pseudoephedrine, l -methylephedrine, and l -norephedrine, are considered as the main active chemical constituents of Ephedra herb, but the misuse and abuse may induce the occurrence of hypertension, insomnia, anxiety, palpitations, arrhythmia, and even sudden death [ 9 , 10 ].…”