(Rimonabant), marketed by Sanofi- Aventis is a selective CB1 endocannabinoid receptor antagonistindicated for the treatment of obesity.

Itsmechanism of action is to block the endogenous cannabinoid binding to neuronalCB1 receptors.

What isendocannabinoid system?

Theendocannabinoid system is in the part of the brain that regulates metabolism, energylevels and appetite.

Withreference to the above drug, endocannabinoid receptors on activation willincrease the appetite. Hence, drugs like Acomplia (Rimonabant) willblock this endocannabinoidreceptor, eventually leading to a decrease in the appetite. It is the mostadvanced endocannabinoid receptor antagonist in clinical development and offersa novel therapeutic approach to appetite control and weight reduction

So what is obesity?

Obesitymedically is defined on the basis of Body Mass Index which is the individual'sbody weight divided by the square of their height in kg/m². So, aBMI of 18.5 to 25 may indicate optimal weight; a BMI lower than 18.5 suggeststhe person is underweight while a number above 25 may indicate the person isoverweight; a BMI below 17.5 may indicate the person has anorexia or a relateddisorder; a number above 30 suggests the person is obese (over 40, morbidlyobese).

So technically speaking, those with their body mass indexof 30 and above tend to fall in the high risk zone. It arises from the accumulation ofexcess fat in the body from over consumption of fatty foods and is now one ofthe most common nutritional disorders in the world.

Latest studies have corroborated the fact that obesity isa silent killer. It is associated with cardiovascular disease, especiallyangina and myocardial infarction, atherosclerosis and arteriosclerosis leadingto cerebrovascular accidents/ strokes.

They also cause joint pains and are also associated withcertain cancers like that of the breast or of the colon. The proportion ofobese individuals in the developed countries has reached epidemic proportions.To put this picture in a better perspective, statistics show that one in five of all Americans areobese and one in three overweight.

In the presence of diabetes mellitus it forms a deadlycombination and is termed as diabetisity. It shows more predilections to Type 2diabetes mellitus

• Serotonin and nor adrenaline reuptake inhibitors (anorectic agents)
• Lipase inhibitors
• ? 3-adrenoreceptor agonists
• Leptin agonists
• Melanocortin-3 agonists

All these strategies have shown some amount of success.

Usually, after having cannabisthese drug addicts suffer from extreme hunger pangs which these smokers referto as ?munchies?. This lead to the belief that cannabinoid is associated withhunger pangs and if this receptor is suppressed it will lead to decreasedappetite which is what precisely the manufacturers of Acomplia [Rimonabant] Sanofi-Aventisdid.

prevents the endogenous cannabinoid binding to CB1 receptors in nerve cells.These CB1 receptors, when activated, stimulate appetite. Hence this drug blocksthe activation of these CB1 receptors and thus reduces appetite.

SIDE EFFECTS:

1. Nausea and vomiting
   Nausea, vomiting and other gastrointestinal disorders were relatively common side effects of taking Acomplia.
2. Disorders of the nervous system
   This category includes headaches, faintness and feeling dizzy.
3. Psychiatric disorders
   Including mood swings, anxiety, depression, irritability, sleep disorders and other similar disorders. The current advice is that you should not take this drug if you suffer from mental health problems. The drug is not suitable for those with continuing major depressive illness and/or antidepressive treatment.

CONTRAINDICATIONS:

1. Any hypersensitivity to the drug or any of its ingredients.
2. Presence of liver damage.
3. Impaired renal function
4. Age more than 75 years and less than 16 years
5. Pregnant and lactating women.
6. In patients with lactose intolerance since it Acomplia contains lactose
7. It should only be used with caution in combination with CYP3A4 inhibitors, such as ketoconazole, ritonavir, Clarithromycin and related drugs.
8. It is not to be prescribed in patients with untreated psychiatric disease.

[Rimonabant] taken for up to two years in conjunction with diet and exerciseproduces greater weight loss than the placebo, although most of the weight lossoccurs in the first year.

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