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2007, Número 4

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Rev Mex Cardiol 2007; 18 (4)


Obesidad. Un problema de peso. El papel terapéutico actual y maduro de la sibutramina. El peso de la evidencia

Morales VEC, González GCA, Hernández GHR

Idioma: Español
Referencias bibliográficas: 76
Paginas: 163-172
Archivo PDF: 141.45 Kb.


RESUMEN

En este artículo se revisa la información más reciente sobre el efecto terapéutico de la sibutramina en los estados de sobrepeso y obesidad con y sin comorbilidades. Ambos, el sobrepeso y la obesidad central, a través de la disfunción adipocitaria y la lipotoxicidad son inductores de resistencia a la insulina y con ello de diabetes mellitus tipo 2 y enfermedad cardiovascular, por ello es deseable cualquier estrategia encaminada al control del peso corporal. La sibutramina es un fármaco que a lo largo de 10 años, tanto en estudios clínicos como en el seguimiento postcomercialización, ha demostrado su eficacia y su seguridad para la reducción ponderal. La sibutramina es un inhibidor de la recaptura de serotonina y de noradrenalina en el SNC, especialmente en el hipotálamo. El incremento paracrino de dichos neurotransmisores, ligandos de los receptores α1 y β1 adrenérgicos, así como de los 2A/2C serotoninérgicos, provoca estimulación y mantenimiento de la saciedad. Colateralmente, la sibutramina limita la regulación a la baja del metabolismo basal asociado a la reducción ponderal y estimula la termogénesis adipocitaria por activación de los receptores periféricos β3 adipocitarios. En los estudios clínicos de largo plazo, se ha documentado una reducción ponderal promedio de 10.2 kilos en 24 meses con el empleo de 10 a 15 mg de sibutramina. Lo anterior con una mejoría global en los marcadores de riesgo cardiometabólico, especialmente del perfil lipídico y glucémico. Estos efectos favorables están bien documentados tanto en obesidad como en sobrepeso asociadas o no a comorbilidades como la diabetes mellitus tipo 2, la hipertensión arterial y la dislipidemia. A más de 10 años de su comercialización la sibutramina es una buena alternativa en el manejo integral de los individuos con sobrepeso y obesidad.


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