There is a wide range of specialist pharmacy services available, one of which is providing treatments and prescriptions for conditions where typical over-the-counter treatments will not be as effective as they need to be.
For example, in certain cases alongside diet and lifestyle changes, the NHS will prescribe certain types of medication that can help people to lose weight and live a healthier life.
Whilst there have been many different types of medication designed to help people either lose weight or not put any on, only two (orlistat and liraglutide) are approved for use by the NHS, designed to stop fat from being absorbed and to suppress appetite respectively.
It takes a long time for a weight loss medication to receive approval, and the best example as to why can be found in the tragic story of fenfluramine/phentermine, better known as Fen-Phen.
At present, the combination is banned in the UK, and only fenfluramine has seen any form of clinical approval by NICE for the treatment of a rare form of epilepsy.
A Tale Of Two Drugs
The story of Fen-Phen began with its two central active ingredients, fenfluramine and phentermine, which were introduced in 1963 and 1959 respectively.
Both work as appetite suppressors, albeit with different effects that on their own were not enough to provide a long-term weight-loss-boosting effect.
For instance, in 1984, a study showed that someone on fenfluramine would lose 7.5kg in six months compared to 4.4kg using a placebo. It would provide some level of weight loss improvement, but not enough to receive more than modest sales and prescriptions.
In July 1992, an article highlighting the benefits of the two drugs in combination was published, and whilst they were not licensed to be taken in combination, doctors can prescribe them in a way that they see fit.
In the United States, especially, Fen-Phen would become wildly popular in a way that would not be seen until the release of Viagra before the release of over-the-counter versions.
This version of the medication was heavily marketed and widely sold right up until the moment that a similar drug was connected to an increased risk of pulmonary hypertension.
Fen-Phen and the related medication dexfenfluramine (sold as Redux) were suddenly under the microscope and in 1994, concerns were raised about its potential risks.
This led to an EU-wide warning of pulmonary hypertension risks but in the US it was approved without the equivalent black box warning in 1996.
Unfortunately, this bureaucratic wrangling resulted in tragedy, as a 30-year-old woman developed heart problems that would, unfortunately, take her life in February 1997.
This led to what had been largely a medical news story becoming an international news story, and by September 1997, the US Food and Drug Administration requested that Fen-Phen and Redux be removed from the market, with an estimated risk of heart and lung issues reaching as high as 30 per cent for long-term users.
Ultimately, phentermine was pulled from the market entirely, but fenfluramine is used for treating seizures related to Dravet syndrome, a complex form of epilepsy.