What are the recommended weight loss medications in the Philippines?

Recommended Weight Loss Medications in the Philippines

In the Philippines, the primary recommended weight loss medications are orlistat, phentermine, and liraglutide, with orlistat being the most widely available option across the country. 1 These medications should be considered as adjuncts to lifestyle modifications including diet and exercise for patients who meet specific BMI criteria.

Available Weight Loss Medications in the Philippines

First-Line Options:

1. Orlistat (Xenical/Alli)

   • Mechanism: Inhibits pancreatic and gastric lipases, blocking absorption of about 30% of ingested fat 1
   • Dosage: 120mg capsule (prescription) or 60mg capsule (over-the-counter) three times daily with meals containing fat 1
   • Efficacy: Average weight loss of 2.89kg at 12 months compared to placebo 1
   • Side effects: Gastrointestinal issues (oily stool, fecal urgency, potential incontinence) 1
   • Special considerations:
     • Take with meals containing approximately 30% calories from fat
     • Must take a multivitamin at bedtime due to decreased absorption of fat-soluble vitamins (A, D, E, K) 1, 2

2. Phentermine (Adipex)

   • Mechanism: Adrenergic agonist that suppresses appetite by activating sympathetic nervous system 1
   • Dosage: 15-37.5mg once daily in the morning 1, 3
   • Efficacy: Average weight loss of 3.6kg at 6 months compared to placebo 1
   • Side effects: Dry mouth, insomnia, dizziness, irritability, elevated blood pressure and heart rate 1
   • Special considerations:
     • Approved only for short-term use (few weeks)
     • Contraindicated in patients with cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma 3
     • Schedule IV controlled substance due to potential for abuse 3

3. Liraglutide (Saxenda)

   • Mechanism: GLP-1 analogue that reduces appetite, increases satiety, and delays gastric emptying 1
   • Dosage: Subcutaneous injection starting at 0.6mg daily, increased weekly by 0.6mg until reaching 3.0mg 1
   • Efficacy: Average weight loss of 4.7% greater than placebo 4
   • Side effects: Nausea, vomiting, diarrhea, constipation 1
   • Special considerations:
     • Discontinue if 4% weight loss not achieved after 16 weeks 1
     • Contraindicated in pregnancy 1

Patient Selection Criteria

Weight loss medications should be prescribed for:

• Adults with BMI ≥30 kg/m² OR
• Adults with BMI ≥27 kg/m² with obesity-related comorbidities (hypertension, type 2 diabetes, dyslipidemia) 1

For Asian populations specifically:

• Consider lower BMI thresholds: ≥27 kg/m² or ≥25 kg/m² with complications 1
• May also consider waist circumference at least 10cm greater than upper limit of normal 1

Treatment Algorithm

1. Initial Approach:

   • Start with comprehensive lifestyle modifications (diet, exercise, behavioral changes)
   • If insufficient weight loss after 3-6 months, consider adding pharmacotherapy

2. Medication Selection:

   • For patients with GI issues/constipation: Consider orlistat
   • For short-term use (few weeks): Consider phentermine
   • For patients with type 2 diabetes: Consider liraglutide (has additional glycemic benefits)
   • For patients with hypertension: Avoid phentermine; consider orlistat

3. Monitoring and Follow-up:

   • Assess efficacy and safety monthly for first 3 months, then quarterly
   • Discontinue medication if:
     • <5% weight loss after 12 weeks on maximum tolerated dose 1
     • Intolerable side effects develop
     • For phentermine: development of tolerance to anorectic effect 3

Important Considerations and Pitfalls

• Duration of therapy: Most medications (except phentermine) are approved for long-term use, but long-term safety data >1 year is limited 1
• Weight regain: Common after medication discontinuation; emphasize ongoing lifestyle modifications 1
• Contraception: Women of reproductive age must use reliable contraception while on these medications 1
• Medication interactions: Review current medications before prescribing weight loss drugs
• Common pitfall: Failure to set realistic expectations - average weight loss with medications is typically 5-10% of initial body weight 4
• Monitoring: Regular follow-up is essential to assess efficacy, side effects, and need for dose adjustments

Weight loss medications should be viewed as tools to help patients achieve clinically meaningful weight loss when combined with lifestyle modifications, not as standalone solutions for obesity management.