What are the medication options for weight loss?

From the Guidelines

Several medications are available for weight loss, including FDA-approved options like orlistat (Xenical, Alli), phentermine (Adipex-P), phentermine-topiramate (Qsymia), lorcaserin (Belviq), bupropion/naltrexone (Contrave), and liraglutide (Saxenda), which work by reducing appetite, increasing feelings of fullness, and slowing gastric emptying. These medications can be effective for short-term use, but they work best when combined with lifestyle changes including diet and exercise, and require medical supervision due to potential side effects like nausea, constipation, and in some cases, more serious cardiovascular concerns 1. Some key points to consider when prescribing these medications include:

• Orlistat (Xenical, Alli) blocks fat absorption in the intestines and is taken with meals, with a recommended dosage of one 120-mg capsule (Xenical) or one 60-mg capsule (Alli) 3 times a day with each main meal containing fat 1.
• Phentermine (Adipex-P) is an adrenergic agonist that promotes weight loss by activating the sympathetic nervous system, with a recommended dosage of 15–37.5 mg orally once daily 1.
• Phentermine-topiramate (Qsymia) is a fixed-dose combination of phentermine and topiramate ER, available in 4 doses, which should be taken once daily in the morning, with gradual dose escalation to minimize risks and adverse events 1.
• Lorcaserin (Belviq) is a serotonin receptor agonist that reduces food intake and increases satiety, with a recommended dose of 10 mg twice daily 1.
• Bupropion/naltrexone (Contrave) combines an addiction medication with an antidepressant to reduce hunger, with a recommended dosage of 8 mg naltrexone and 90 mg bupropion, initially 1 tablet daily, with instructions to increase by 1 tablet a week to a maximum dose of 2 tablets in the morning and 2 tablets in the evening (32/360 mg) 1.
• Liraglutide (Saxenda) is a GLP-1 analogue that reduces energy intake by reducing appetite, increasing satiety, and delaying gastric emptying, with a recommended dosage of 3.0 mg daily, initiated at 0.6 mg daily for 1 week, with instructions to increase by 0.6 mg weekly until 3.0 mg is reached 1. Most weight loss medications are intended for people with BMI ≥30 or BMI ≥27 with weight-related health conditions, and insurance coverage varies significantly 1. It's essential to consider the potential benefits and risks of these medications, as well as the importance of lifestyle changes, when making treatment decisions for patients with obesity. Additionally, the choice of medication should be individualized based on the patient's medical history, potential side effects, and other factors, such as the presence of comorbidities like type 2 diabetes or cardiovascular disease 1. Overall, while these medications can be effective for weight loss, they should be used in conjunction with a comprehensive treatment plan that includes diet, exercise, and behavioral counseling, and under the guidance of a healthcare professional.

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 medication option for weight loss is phentermine.

• Indications: Phentermine is indicated for the management of exogenous obesity in patients with a body mass index (BMI) 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.
• Dosage: The usual adult dose is 15 mg to 30 mg at approximately 2 hours after breakfast for appetite control.
• Important considerations: Phentermine is only recommended for short-term use (a few weeks) and should be used as part of a weight reduction program that includes exercise, behavioral modification, and caloric restriction 2.

From the Research

Medication Options for Weight Loss

There are several medication options available for weight loss, including:

• Orlistat: a lipase inhibitor that blocks the absorption of dietary fat 3, 4, 5, 6
• Phentermine/topiramate: a combination medication that suppresses appetite and increases feelings of fullness 3, 6, 7
• Naltrexone/bupropion: a combination medication that works by decreasing hunger and increasing feelings of fullness 3, 6, 7
• Liraglutide: a medication that mimics the actions of a hormone that regulates appetite and metabolism 3, 6, 7
• Semaglutide and tirzepatide: medications that mimic the actions of enteropancreatic hormones that modify central appetite regulation and provide multiple cardiometabolic weight-loss benefits 6

Efficacy of Medication Options

The efficacy of these medication options varies, with:

• Orlistat associated with a 2.9-3.1% greater weight loss compared to placebo 3, 6
• Phentermine/topiramate associated with a 6.8-8.0% greater weight loss compared to placebo 3, 6
• Naltrexone/bupropion associated with a 4.0-4.1% greater weight loss compared to placebo 3, 6
• Liraglutide associated with a 4.7-5.4% greater weight loss compared to placebo 3, 6
• Semaglutide and tirzepatide associated with an 11.4-12.4% greater weight loss compared to placebo 6

Considerations for Medication Use

When considering medication options for weight loss, it is essential to:

• Weigh the benefits and risks of each medication 3
• Consider individual comorbidities, patient choice, and cost 7
• Select a medication that is tailored to the specific needs of the patient 3
• Use medications in combination with lifestyle interventions, such as diet and exercise 3, 6