Sibutramine, formerly sold under the brand name Meridia among others, is an appetite suppressant which has been discontinued in many countries. It works as a serotonin–norepinephrine reuptake inhibitor similar to a tricyclic antidepressant. Until 2010, it was widely marketed and prescribed as an adjunct in the treatment of obesity along with diet and exercise. It has been associated with increased cardiovascular events and strokes and has been withdrawn from the market in 2010 in several countries and regions including Australia, Canada, China, the European Union, Hong Kong, India, Mexico, New Zealand, the Philippines, Thailand, the United Kingdom, and the United States. However, the drug remains available in some countries. Sibutramine was originally developed in 1988 by Boots in Nottingham, UK, and manufactured and marketed by Abbott Laboratories and sold under a variety of brand names including Reductil, Meridia, Siredia, and Sibutrex before its withdrawal 2010 from most markets. It was classified as a Schedule IV controlled substance in the United States. As of 2018, the FDA still found sibutramine in over 700 diet supplements marketed as "natural", "traditional" or "herbal remedies". Medical uses Sibutramine has been used to produce appetite suppression for the purpose of attaining weight loss in the treatment of patients with obesity. Contraindications Sibutramine is contraindicated in patients with: Psychiatric conditions as bulimia nervosa, anorexia nervosa, serious depression or pre-existing mania Patients with a history of or a predisposition to drug or alcohol abuse Hypersensitivity to the drug or any of the inactive ingredients Patients below 18 and above 65 years of age Concomitant treatment with a MAO inhibitor, antidepressant or other centrally active drugs, particularly other anoretics History of peripheral arterial disease Hypertension that is not sufficiently controlled (e.g., >145/90 mmHg), caution in controlled hypertension Existing pulmonary hypertension Existing damage on heart valves, coronary heart disease, congestive heart failure, serious arrhythmias, previous myocardial infarction A history of coronary artery disease (e.g., angina, history of myocardial infarction), congestive heart failure, tachycardia, peripheral arterial occlusive disease, arrhythmia or cerebrovascular disease (stroke or transient ischemic attack (TIA)) Stroke or transient ischemic attack (TIA) Hyperthyroidism (overactive thyroid gland) Closed angle glaucoma Seizure disorders Enlargement of the prostate gland with urinary retention (relative contraindication) Pheochromocytoma Pregnant and lactating women (relative contraindication) Side effects A higher number of cardiovascular events has been observed in people taking sibutramine versus control (11.4% vs. 10.0%). In 2010 the FDA noted the concerns that sibutramine increases