From the Guidelines
The most effective oral medications for weight loss, as supported by the latest evidence, include semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER, which should be used in conjunction with lifestyle interventions for adults with overweight and obesity. When considering oral weight loss medications, it's essential to evaluate the available options based on their efficacy, safety, and potential side effects. The medications mentioned above have been recommended by the guideline panel based on moderate certainty evidence 1. Some key points to consider when prescribing these medications include:
- Semaglutide 2.4 mg and liraglutide 3.0 mg are GLP-1 receptor agonists that work by reducing appetite and increasing feelings of fullness.
- Phentermine-topiramate ER and naltrexone-bupropion ER are combination medications that target different pathways to reduce hunger and increase satiety.
- These medications should be used alongside calorie reduction and increased physical activity for optimal results.
- Regular monitoring is necessary to assess effectiveness and manage potential side effects, which can include gastrointestinal issues, headaches, and increased heart rate.
- It's crucial to consult with a healthcare provider before starting any weight loss medication, as they may not be suitable for everyone, particularly those with certain heart conditions, pregnancy, or a history of eating disorders. In contrast, orlistat is no longer recommended due to its limited efficacy and potential side effects 1. Other options like phentermine and diethylpropion may be considered based on low certainty evidence, but their use should be carefully evaluated on a case-by-case basis 1. Ultimately, the choice of medication will depend on the individual patient's needs, medical history, and tolerance to potential side effects.
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 available oral medication for weight loss is Phentermine.
- Key points:
- Indicated for short-term use in exogenous obesity management
- Should be used in conjunction with exercise, behavioral modification, and caloric restriction
- Recommended for patients with a BMI of 30 kg/m2 or higher, or 27 kg/m2 or higher with other risk factors
- Available in 15 mg and 30 mg capsules 2, 2, 2
From the Research
Available Oral Medications for Weight Loss
The following oral medications are available for weight loss:
- Orlistat: works by decreasing fat absorption 3, 4, 5, 6, 7
- Phentermine/topiramate: works by suppressing appetite 3, 4, 5, 6, 7
- Naltrexone/bupropion: works by suppressing appetite 3, 4, 5, 6, 7
- Liraglutide: works by suppressing appetite 3, 4, 5, 6, 7
- Phentermine: works by suppressing appetite 5
FDA Approval and Usage
These medications have been approved by the FDA for chronic weight management:
- Orlistat, phentermine/topiramate, naltrexone/bupropion, and liraglutide are approved for long-term use 3, 4, 5, 6
- Lorcaserin was previously approved but has been withdrawn from the market due to increased risk of cancer 3, 4
Considerations for Use
When considering the use of these medications, the following factors should be taken into account:
- Benefits and risks of the medication should be weighed for each individual patient 3, 4, 5, 6
- Medications should be tailored to specific patient subpopulations depending on their chronic conditions, comorbidities, and preferences 3, 4, 5, 6
- Lifestyle modifications should be continued and emphasized throughout treatment 5
- Drug therapy should be customized to the individual patient, depending on needs, contraindications, and cost 5