DATE: Wednesday, September 17, 1997         TAG: 9709170477

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY PAT DOOLEY, STAFF WRITER 

                                            LENGTH:  104 lines

LOSS OF 2 POPULAR DRUGS HAS DIETERS SCRAMBLING LOCAL SPECIALISTS OFFER ALTERNATIVES TO WORRIED PATIENTS.

Despite serious health risks associated with two diet drugs pulled from the market this week, some patients are disappointed they can no longer get the pills that have helped them shed pounds.

On Tuesday, Virginia's obesity specialists began helping those patients choose alternatives to dexfenfluramine, or Redux, and fenfluramine, half of the popular weight-loss combo dubbed ``fen-phen.''

``I've had a lot of teary eyes,'' said Dr. Lisa Harris, an obesity specialist with offices in Chesapeake and Virginia Beach. She was busy answering questions from patients who called or had appointments.

The prescription drugs became unavailable to consumers Monday after their manufacturer, American Home Products Corp., voluntarily stopped sales at the request of the U.S. Food and Drug Administration.

The FDA said it was acting on growing evidence of ``significant side effects,'' including heart-valve disease in more than 100 people who have used the drugs.

Phentermine, the other half of fen-phen, was not included in the withdrawal. It has not been associated with heart-valve disease, the FDA said.

Many who came to see Harris Tuesday don't want to stop taking the drugs, she said. In some cases, patients have lost 60 pounds or more using fen-phen or Redux, combined with nutrition and exercise counseling.

``For many people who have been overweight, they haven't had any other help,'' said Harris, who only prescribed the medications to treat obesity - defined as 20 percent or more over ideal body weight.

Penny Sherman of Virginia Beach has struggled with her weight for much of her life.

About four months ago, Sherman, 48, consulted with Harris and began a fen-phen regimen. Sherman considered herself a savvy consumer - she'd researched the drugs for a recent sociology class.

She saw Harris regularly, weekly for the first month, and made sure she had the appropriate medical tests, including two electrocardiograms of her heart.

Sherman lost 44 pounds and felt great. She only wanted to use fen-phen for about five months and is disappointed that she cannot.

Now, she's using phentermine. It helps curb her appetite, she says, but she has to be more conscious of her food choices.

``That's the way the rest of my life is going to have to be,'' says Sherman.

She believes the FDA acted appropriately but blames physicians she says overprescribed diet drugs for people whose health didn't depend on losing weight.

Harris, one of Virginia's two board-certified specialists in bariatrics, the study of obesity, said none of her patients have experienced problems with the drugs.

``They're wondering, `What am I going to do now?' '' she said.

Harris, who prescribed fen-phen for about 200 of her 2,000 patients, and Redux for about 15, wants them to know there are alternatives.

Phentermine, which suppresses appetite by altering a brain chemical called noradrenaline, is among them.

Similar drugs that affect noradrenaline may help obese patients, too, said Dr. Denise E. Bruner, Virginia's other board-certified bariatrics specialist.

The drugs include mazindol and diethylpropion, said Bruner, who fielded about 40 patients' calls to her Arlington office on Tuesday.

She tells her patients to taper off the withdrawn drugs to avoid side effects such as mild depression and loss of sleep.

She also tells them not to give up hope. Many of her patients have taken phentermine with good results.

Other drugs may be on the horizon, including one that blocks the body's absorption of fat, she said.

And the traditional advice - healthful eating habits and exercise - still stands, she said.

The FDA isn't saying if fenfluramine or dexfenfluramine will return to pharmacy shelves.

The agency is working with the Centers for Disease Control and Prevention and the National Institutes of Health to learn more about the drugs, said FDA spokeswoman Marian Segal.

Dexfenfluramine was approved by the FDA in April 1996. But the drug's labeling stated that safety had not been shown for more than a year of use. That reflected the length of the European study upon which the drug was approved, the FDA said this week.

There was no reason to believe at the time that the heart was affected, the agency said. Dexfenfluramine had been used in Europe for more than a decade without reported associations with heart-valve disease.

The fen-phen drugs - fenfluramine and phentermine - each had been approved for weight loss more than 20 years ago. The FDA never advised using them together. About five years ago, physicians started prescribing them in tandem.

The FDA calls that ``off-label use.'' No studies presented to the agency demonstrated the combination's safety or effectiveness, Segal said.

That is true for some other combinations popping up on the weight-loss scene, she said.

One national center reportedly prescribes phentermine with the popular antidepressant Prozac.

Like fenfluramine, Prozac affects the brain chemical serotonin. That may help regulate a person's craving for carbohydrates, some experts say.

But Prozac has not been approved for weight loss, Segal said.

The FDA also urges caution when using over-the-counter dietary supplements.

Some, such as ``Herbal Phen-Fen,'' do not contain either of the withdrawn drugs but do contain ephedra, a heart and nervous system stimulant linked to more than 800 illnesses and about 40 deaths in the United States since 1994. ILLUSTRATION: Color photo

IAN MARTIN/The Virginian-Pilot

Dr. Lisa Harris, an obesity specialist, spent much of Tuesday

answering questions from patients about the withdrawn diet drugs

dexfenfluramine and fenfluramine at The Chase Wellness Center in

Virginia Beach.

Send Suggestions or Comments to webmaster@scholar.lib.vt.edu