Can a 30-year-old female with tachycardia, abnormal uterine bleeding (AUB), hypertension (HTN), and morbid obesity safely take all her medications, including lisinopril, together and consider additional medication for weight loss?

From the Guidelines

The patient should take all her prescribed medications together, including lisinopril for hypertension, and any medications for tachycardia and abnormal uterine bleeding, while also considering semaglutide 2.4 mg with lifestyle modifications for weight loss, as recommended by the American Gastroenterological Association 1. These medications are generally safe to take simultaneously, but should be taken according to their specific instructions (with or without food, time of day). For weight loss, FDA-approved medications like semaglutide (Wegovy) could be considered after evaluating her complete medical history and current medications for potential interactions, as it has been suggested to be prioritized over other approved anti-obesity medications for the long-term treatment of obesity for most patients 1. Lifestyle modifications including a reduced-calorie diet and regular physical activity should accompany any weight loss medication. Weight loss would be beneficial for her hypertension and could improve her overall cardiovascular health. Before starting any weight loss medication, she should have a thorough evaluation to determine the most appropriate option based on her specific health conditions, especially considering her tachycardia which may limit the use of stimulant-based weight loss medications, and her history of abnormal uterine bleeding, which may require careful consideration of hormonal therapies 1. Regular follow-up appointments will be necessary to monitor medication effectiveness and potential side effects, such as nausea and vomiting associated with semaglutide, and to adjust the treatment plan as needed 1.

Some key points to consider when evaluating weight loss medications for this patient include:

• The potential benefits and risks of each medication, including the risk of pancreatitis and gallbladder disease associated with GLP-1 receptor agonists like semaglutide 1
• The patient's medical history, including her tachycardia, abnormal uterine bleeding, and hypertension, and how these conditions may be affected by weight loss medications 1
• The importance of lifestyle modifications, including a reduced-calorie diet and regular physical activity, in achieving and maintaining weight loss 1
• The need for regular follow-up appointments to monitor medication effectiveness and potential side effects, and to adjust the treatment plan as needed 1

From the FDA Drug Label

The safety and efficacy of combination therapy with phentermine and any other drug products for weight loss including prescribed drugs, over-the-counter preparations, and herbal products, or serotonergic agents such as selective serotonin reuptake inhibitors (e.g., fluoxetine, sertraline, fluvoxamine, paroxetine), have not been established. History of cardiovascular disease (e.g., coronary artery disease, stroke, arrhythmias, congestive heart failure, uncontrolled hypertension)

The patient has a history of tachycardia and hypertension (HTN), which are contraindications for the use of phentermine. Additionally, the patient is taking lisinopril, and there is no information on the safety of combining phentermine with this medication.

• The patient should not be prescribed phentermine due to the potential risks associated with her medical history.
• The patient's current medications, including lisinopril, should be reviewed and managed appropriately before considering any new medications.
• Alternative weight loss strategies, such as diet and exercise, should be discussed with the patient. 2 2 2

From the Research

Medication Interactions and Weight Loss

• The patient is currently taking lisinopril and is seeking clarification on whether she can take all her medications together 3.
• There is no direct evidence in the provided studies regarding the interaction between lisinopril and other medications the patient may be taking.
• However, studies have shown that weight loss medications such as orlistat, phentermine/topiramate, and naltrexone/bupropion can be effective in reducing body weight and improving blood pressure in individuals with hypertension 3, 4, 5, 6, 7.

Weight Loss Medications

• Orlistat has been shown to reduce systolic and diastolic blood pressure compared to placebo, with a mean difference of -2.6 mm Hg and -2.0 mm Hg, respectively 3, 5.
• Phentermine/topiramate has been shown to reduce body weight and improve blood pressure, with an average weight loss of 7.73 kg compared to placebo 7.
• Naltrexone/bupropion has been shown to reduce body weight, but its effect on blood pressure is unclear, with one study showing no difference in blood pressure compared to placebo 3, 4.

Safety and Adverse Events

• The most common adverse events associated with orlistat are gastrointestinal side effects, such as diarrhea and abdominal pain 3, 5.
• Phentermine/topiramate has been associated with nervous system-related adverse events, such as dysgeusia, paresthesia, and dry mouth 7.
• Naltrexone/bupropion has been associated with an increased incidence of overall adverse events, including nausea, headache, and dizziness 3, 4.