From the Guidelines
I strongly recommend considering oral weight loss medications like phentermine or bupropion/naltrexone (Contrave) since injectable options aren't covered by your insurance. Phentermine (typically 15-37.5mg daily, taken in the morning) is an appetite suppressant that can be effective for short-term use (usually up to 12 weeks) 1. Bupropion (150-300mg daily) might be particularly suitable as it has fewer interactions with your current medications, Lexapro and Buspar. Naltrexone-bupropion combines bupropion with naltrexone and can be taken as directed, usually titrated up to two tablets twice daily.
Key Considerations
- Before starting any of these, consult with your healthcare provider as they may need to monitor for potential interactions with Lexapro and Buspar.
- These medications work by either suppressing appetite or affecting brain chemistry related to hunger and cravings.
- Additionally, incorporate lifestyle modifications like calorie reduction and increased physical activity to maximize effectiveness.
- Be aware that some side effects may include insomnia, dry mouth, constipation, or increased blood pressure, so regular monitoring is important.
Medication Options
- Phentermine: 15-37.5mg daily, taken in the morning
- Bupropion/naltrexone (Contrave): titrated up to two tablets twice daily
Important Notes
- The choice of agent will depend on the side effects profile of each drug and the patient's tolerance of those side effects 1.
- There are no data to determine whether one drug is more efficacious than another, and there is no evidence for increased weight loss with combination therapy 1.
From the Research
Weight Loss Medications
Given the lack of insurance coverage for injectable weight loss medications and the patient's current medications, lexapro and buspar, the following weight loss medications can be considered:
- Orlistat: approved by the FDA for chronic weight management, with a placebo-subtracted weight reduction of 2.9% 2
- Phentermine/topiramate: approved by the FDA for chronic weight management, with a placebo-subtracted weight reduction of 6.8% 2, and has been shown to have beneficial effects on cardiometabolic risk 3, 4
- Naltrexone/bupropion: approved by the FDA for chronic weight management, with a placebo-subtracted weight reduction of 4.0% 2
- Liraglutide: approved by the FDA for chronic weight management, with a placebo-subtracted weight reduction of 5.4% 2
Considerations
When selecting a weight loss medication, it is essential to consider the patient's chronic conditions, comorbidities, and preferences 2. Additionally, the potential risks and benefits of each medication should be weighed, including the increased risk of cancer associated with lorcaserin, which has been withdrawn from the market 2, and the increased heart rate associated with phentermine-topiramate ER 4.
Medication Interactions
There is limited information available on the interactions between these weight loss medications and lexapro and buspar. However, it is crucial to monitor the patient's response to the medication and adjust the treatment plan as needed.
Dosage and Administration
The dosage and administration of these medications can vary, and it is essential to follow the recommended guidelines. For example, phentermine/topiramate ER can be administered in the morning or afternoon, with a dose of 15 mg/92 mg resulting in an average weight loss of 10% of initial weight 4.