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Management
Obesity and Idiopathic Intracranial Hypertension (IIH)
➤ IIH is a disorder of increased intracranial pressure resulting in
headaches, papilledema, transient vision loss, diplopia, and/or
pulsatile tinnitus. If left untreated, it may cause permanent
vision loss.
➤ IIH development and severity are strongly associated with
weight gain and obesity, particularly in women of childbearing
age. Weight loss of 5% to 10% results in clinically significant
improvements in headache, tinnitus, intracranial pressure, and
papilledema. A 15% weight loss may result in remission of IIH.
➤ When IIH is suspected, referrals to neurology and ophthalmology
should be considered. Brain imaging results are typically normal,
and diagnosis is based on papilledema and elevated opening
pressure on lumbar puncture.
➤ Acetazolamide, a carbonic anhydrase inhibitor, reduces
cerebrospinal fluid production. Topiramate also weakly inhibits
carbonic anhydrase and can be used as an alternative agent or
adjunct to other treatments.
Obesity, Depression, and Anxiety
➤ Weight loss in patients with obesity can improve mood in those
with or without a clinical diagnosis of a mood disorder.
➤ Management of mood disorders may include cognitive behavioral
therapy and pharmacological approaches, and may involve
primary care clinicians, psychologists, and psychiatrists.
➤ Phentermine or bupropion use within 14 days of monoamine
oxidase inhibitor use may increase the risk of hypertensive crisis.
➤ Bupropion inhibits CYP2D6 and can affect concentrations
of selective serotonin reuptake inhibitors (SSRIs), tricyclics,
and antipsychotics. The need to decrease the dose of a
CYP2D6-metabolized medication should be considered if it is
coadministered with bupropion or naltrexone hydrochloride
(HCl)/bupropion HCl extended release.
➤ Metformin and glucagon-like peptide-1 receptor agonists may
help mitigate weight gain associated with antipsychotics.
