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Sibutramine works primarily in the central nervous system by blocking presynaptic reuptake transporters for serotonin (5-HT) and norepinephrine (NE), increasing extracellular levels of these neurotransmitters in hypothalamic and other appetite-regulating regions. This leads to amplified satiety signals via 5-HT2C and α1-adrenergic receptor activation, reduced food intake, and secondary increases in energy expenditure through sympathetic nervous system activation. Its active metabolites (M1 and M2) contribute significantly to its prolonged pharmacological effects.
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