What is the most affordable medication for weight loss in a non-diabetic patient?

From the Guidelines

The most affordable medication for weight loss in a non-diabetic patient is generic phentermine, which typically costs $10-30 per month. Phentermine is an FDA-approved appetite suppressant usually prescribed at 15-37.5mg taken once daily in the morning 1. Treatment duration is generally limited to 12 weeks due to potential for tolerance and side effects. Phentermine works by increasing norepinephrine in the brain, which reduces hunger signals and helps patients consume fewer calories. It's most effective when combined with calorie reduction and increased physical activity. Some key points to consider when prescribing phentermine include:

• Common side effects include dry mouth, insomnia, constipation, and increased heart rate 1.
• Phentermine should be avoided in patients with cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, or history of drug abuse.
• The choice of agent will depend on the side effects profile of each drug and the patient's tolerance of those side effects 1.
• While newer weight loss medications like semaglutide (Wegovy) or tirzepatide (Zepbound) may be more effective, they cost significantly more at $900-1300 monthly without insurance coverage, making phentermine the most budget-friendly prescription option for weight management. Some of the benefits of weight loss with phentermine include:
• Decreased progression to type 2 diabetes mellitus 1.
• Positive influence on other obesity-associated cardiovascular risk factors, such as lipid levels and hypertension 1.

From the FDA Drug Label

Phentermine Hydrochloride, USP 15 mg and 30 mg is indicated as a short-term (a few weeks) adjunct in a regimen of weight reduction based on exercise, behavioral modification and caloric restriction in the management of exogenous obesity for patients with an initial body mass index greater than or equal to 30 kg/m 2, or greater than or equal to 27 kg/m 2 in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).

The most affordable medication for weight loss for a patient without diabetes is not explicitly stated in the provided drug label. However, phentermine is mentioned as an option for weight loss in patients with a BMI greater than or equal to 30 kg/m2 or greater than or equal to 27 kg/m2 with other risk factors.

• The cost of phentermine is not provided in the label.
• The label does mention that phentermine is indicated for short-term use and should be used as part of a regimen that includes exercise, behavioral modification, and caloric restriction.
• It is also important to note that phentermine has potential risks and side effects, including primary pulmonary hypertension, valvular heart disease, and abuse and dependence. 2

From the Research

Medication Options for Weight Loss

• Orlistat is a commonly used medication for weight loss, and it has been shown to be effective in reducing body weight in obese adults and adolescents with or without comorbidities, including type 2 diabetes mellitus 3, 4, 5.
• Orlistat works by inhibiting gastrointestinal lipases, which prevents the absorption of dietary fat, and it is generally well tolerated with gastrointestinal adverse events being most commonly reported 4, 5.
• Other medications, such as fluoxetine and sibutramine, have also been shown to produce modest reductions in weight, but their safety and long-term health benefits are uncertain 6.

Cost-Effectiveness of Orlistat

• Orlistat has been shown to be cost-effective in patients with obesity, particularly those with type 2 diabetes 4.
• The cost-effectiveness of orlistat makes it an attractive option for the treatment of patients with obesity, especially those with associated comorbidities or at risk of developing type 2 diabetes 4, 5.

Comparison with Other Medications

• Orlistat has been compared to other medications, such as sibutramine and fluoxetine, and it has been shown to be effective in achieving modest weight loss 6.
• However, the magnitude of weight loss with orlistat is modest, and the long-term health benefits remain unclear 6.
• Other medications, such as tesofensine, phentermine + topiramate, bupropion + naltrexone, and bupropion + zonisamide, are currently being studied, but their efficacy and safety are not yet fully established 3.