What are the medications for obesity?

From the Guidelines

Medications for obesity should include semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER as first-line options, in addition to lifestyle interventions, for adults with a body mass index of 30 kg/m2 or 27 kg/m2 with weight-related complications. The use of these medications is supported by the most recent guideline on pharmacological interventions for adults with obesity, which suggests their use based on moderate certainty evidence 1.

Key Considerations

• The guideline panel strongly recommends the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity who have an inadequate response to lifestyle interventions 1.
• Semaglutide 2.4 mg, liraglutide 3.0 mg, phentermine-topiramate ER, and naltrexone-bupropion ER are suggested for long-term management of overweight and obesity, based on moderate certainty evidence 1.
• Orlistat is suggested against due to its limited efficacy and potential side effects, as noted in previous studies 1.
• The use of Gelesis100 oral superabsorbent hydrogel is identified as a knowledge gap, indicating a need for further research on its effectiveness for obesity management 1.

Clinical Implications

• Medications for obesity should be used in conjunction with lifestyle interventions, including diet and exercise, to achieve optimal weight loss and improve overall health outcomes.
• Regular monitoring for side effects and effectiveness is essential, and patients should understand that weight regain is common if medication is discontinued.
• The choice of medication should be individualized based on patient characteristics, medical history, and potential side effects.

From the FDA Drug Label

Phentermine is a sympathomimetic amine with pharmacologic activity similar to the prototype drugs of this class used in obesity, amphetamine (d- and dll-amphetamine). Drugs of this class used in obesity are commonly known as “anorectics” or “anorexigenics. ” It has not been established that the primary action of such drugs in treating obesity is one of appetite suppression since other central nervous system actions, or metabolic effects, may also be involved.

Medications for Obesity:

• Phentermine is used for the management of exogenous obesity.
• The primary action of phentermine in treating obesity is not established, but it may involve appetite suppression, central nervous system actions, or metabolic effects.
• Phentermine is a sympathomimetic amine with pharmacologic activity similar to amphetamine.
• Phentermine is commonly known as an “anorectic” or “anorexigenic” drug.
• The use of phentermine for weight loss should be done under the guidance of a healthcare professional, as it can have serious side effects and interactions with other medications 2, 2, 2.

From the Research

Medications for Obesity

• Orlistat is a non-centrally acting anti-obesity agent that inhibits lipase, an enzyme crucial for the digestion of long-chain triglycerides 3.
• At the recommended dose of 120 mg three times daily, orlistat inhibits dietary fat absorption by about 30% and reduces weight in obese adults and adolescents with or without comorbidities 4, 5.
• Orlistat in combination with a hypocaloric diet improves metabolic risk factors and reduces the risk of developing type 2 diabetes 4, 5.
• In addition to orlistat, there are six other FDA-approved anti-obesity medications: phentermine, phentermine/topiramate ER, naltrexone SR/bupropion SR, liraglutide 3.0 mg, semaglutide 2.4 mg, and tirzepatide 6.
• These medications should be prescribed with the intention of long-term use, as obesity is a chronic disease 6.
• Orlistat has a good safety profile, but a high rate of gastrointestinal side effects limits adherence to treatment 7.

Benefits of Orlistat

• Reduces weight in obese adults and adolescents with or without comorbidities 4, 5.
• Improves metabolic risk factors, such as total and low-density lipoprotein cholesterol, blood pressure, and plasma glucose 3, 4.
• Reduces the risk of developing type 2 diabetes 4, 5.
• Has a good safety profile, with serious adverse events being rare 7.

Other Anti-Obesity Medications

• Phentermine, phentermine/topiramate ER, naltrexone SR/bupropion SR, liraglutide 3.0 mg, semaglutide 2.4 mg, and tirzepatide are FDA-approved anti-obesity medications 6.
• These medications have different mechanisms of action, dosing, and side effects 6.