What diet medications are safe for patients with heart problems?

From the Guidelines

For patients with heart problems, orlistat is the safest diet medication option, as it has been specifically studied in cardiac populations and has minimal cardiovascular effects. This is based on the most recent and highest quality study available, which found that orlistat can be safely used in patients with heart failure, resulting in significant weight loss and improvement in 6-minute walk distance and NYHA class 1. The typical dose of orlistat is 120mg three times daily with meals containing fat (prescription strength) or 60mg three times daily (over-the-counter strength).

Some key points to consider when prescribing diet medications to patients with heart problems include:

• Avoiding older diet medications like phentermine, diethylpropion, or combinations containing stimulants, as these can increase heart rate and blood pressure 1
• Considering newer medications like liraglutide (Saxenda) or semaglutide (Wegovy) under close medical supervision, as they may provide cardiovascular benefits for some patients
• Ensuring a thorough cardiovascular evaluation is performed before starting any weight loss medication, with regular monitoring of heart function, blood pressure, and electrolytes during treatment 1
• Recognizing that weight loss itself, even modest amounts of 5-10%, can significantly improve cardiac health by reducing strain on the heart, improving blood pressure, and enhancing metabolic parameters

It's also important to note that purposeful weight loss via healthy dietary intervention, physical activity, or weight loss drugs such as orlistat may be reasonable in obese patients with heart failure to improve health-related quality of life or manage comorbidities such as diabetes mellitus, hypertension, or sleep apnea 1. However, the benefit of weight loss in reducing morbidity or mortality in heart failure is uncertain, and more research is needed to fully understand the effects of weight loss on cardiac health 1.

From the FDA Drug Label

WARNINGS AND PRECAUTIONS ... Use caution in patients with even mild hypertension (risk of increase in blood pressure). Rare cases of primary pulmonary hypertension have been reported. Rare cases of serious regurgitant cardiac valvular disease have been reported. Phentermine should be discontinued in case of new, unexplained symptoms of dyspnea, angina pectoris, syncope or lower extremity edema.

Key Considerations:

• Phentermine may not be suitable for patients with heart problems due to the risk of primary pulmonary hypertension, serious regurgitant cardiac valvular disease, and other cardiac symptoms.
• Orlistat does not have direct warnings related to heart problems, but it may interact with certain heart medications, such as amiodarone.
• When considering diet medications for patients with heart problems, it is essential to weigh the potential benefits against the risks and carefully monitor the patient's condition.

Recommended Approach:

• For patients with heart problems, orlistat may be a safer option than phentermine, but it is crucial to consult with a doctor or pharmacist to discuss potential interactions with other medications and monitor the patient's condition closely 2.
• Patients with heart problems should be closely monitored for any adverse reactions when taking diet medications, and the medication should be discontinued if any new or unexplained symptoms occur 3.

From the Research

Diet Medications for Patients with Heart Problems

• The following diet medications have been studied for their safety and efficacy in patients with heart problems:
  • Orlistat 4, 5
  • Phentermine/topiramate 4, 5, 6
  • Naltrexone/bupropion 4
  • Liraglutide 7
  • Semaglutide 7
• These medications have been shown to improve weight and metabolic parameters, with variable potency and effects depending on the specific drug 7.
• However, the currently available data do not support a reduction in hard cardiovascular outcomes, but it is expected that such data will be forthcoming in the near future 7.

Safety Considerations

• The choice of anti-obesity medication should take into consideration the patient's clinical and biochemical profile, co-morbidities, and drug contra-indications, as well as expected degree of weight loss and improvements in cardio-renal and metabolic risk 7.
• Some medications, such as phentermine/topiramate, have been associated with safety concerns and have been refused marketing authorization in some countries 4, 5.
• Other medications, such as lorcaserin, have been withdrawn from the market due to safety concerns 4, 5.

Effects on Cardiovascular Risk Factors

• Orlistat has been shown to reduce systolic and diastolic blood pressure compared to placebo 4, 5.
• Phentermine/topiramate has been shown to reduce blood pressure and improve lipid variables in patients with dyslipidemia and/or hypertension 6.
• Naltrexone/bupropion has been shown to reduce body weight, but its effect on blood pressure is unclear 4.