The safety profiles of orlistat and sibutramine: results of prescription-event monitoring studies in England.
BACKGROUND
Observational cohort studies were conducted using prescription-event monitoring (PEM) to examine the safety profiles of the anti-obesity agents orlistat and sibutramine. Adverse events reported as case reports were also evaluated to determine whether these events were also identified by PEM.


METHODS
Patients were identified from dispensed prescriptions written by general practitioners (GPs) in England for orlistat or sibutramine. Patient demographic and clinical event information, including reasons for stopping and adverse drug reactions, were requested on questionnaires posted to GPs at least 6 months after the first prescription for individual patients. Event incidence densities (IDs) (number of first reports of event/1000 patient-months treatment) were calculated for month 1 (ID(1)) and months 2-3 (ID(2-3)). Published case reports were identified by searching Medline and Embase.


RESULTS
The cohorts comprised 16,021 and 12,336 patients prescribed orlistat and sibutramine, respectively. Both cohorts had a median age of 45 years, and approximately 80% were female. The most common reason for stopping orlistat within 3 months was diarrhea (332 patients; 2.1% cohort), and for stopping sibutramine it was hypertension (203 patients; 1.6%). Clinical events significantly associated with taking orlistat were mainly gastrointestinal and those for sibutramine included central nervous system effects, nausea/vomiting, palpitation, and sweating. We identified 8 published case reports for orlistat and 10 for sibutramine that had equivalent or similar events assessed as causally related in the PEM studies.


CONCLUSIONS
The PEM studies highlighted different adverse event profiles for orlistat and sibutramine that were consistent with their distinct pharmacological mechanisms and other published information.
Perrio
Michael J
MJ
Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, United Kingdom S031 1AA. michael.perrio@dsru.org
Wilton
Lynda V
LV
Shakir
Saad A W
SA
D000014:Abnormalities, Drug-Induced; D000022:Abortion, Spontaneous / Q000139:chemically induced; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D019440:Anti-Obesity Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001067:Appetite Depressants / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003503:Cyclobutanes / Q000009:adverse effects* / Q000627:therapeutic use; D016903:Drug Monitoring; D004739:England; D005260:Female; D006801:Humans; D007783:Lactones / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009765:Obesity / Q000188:drug therapy*; D000077403:Orlistat; D011247:Pregnancy; D011256:Pregnancy Outcome; D013546:Sweating / Q000187:drug effects; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D019440:Anti-Obesity Agents; D001067:Appetite Depressants; D003503:Cyclobutanes; D007783:Lactones; D000077403:Orlistat; C058254:sibutramine