Table 14.
Food and Drug Administrationeapproved Pharmacotherapy for Weight Loss in Persons with Adiposity-based Chronic Disease
| Weight-loss medication | Dose; escalate as tolerated | Mechanism | Potential side effects | Warnings and contraindicationsa |
|---|---|---|---|---|
| Approved for short-term therapy (≤3 mo) | ||||
| Phentermine | Low-dose 15 mg every day; maximum dose 37.5 mg every day (by mouth)b | Sympathomimetic amine (decreases appetite); stimulates CNS activity | Restlessness, insomnia, headache, dry mouth, tachycardia, BP elevation | Pregnancy, active coronary artery disease, uncontrolled hypertension, hyperthyroidism, agitated states |
| Approved for chronic management of obesity | ||||
| Orlistat | Treatment dose 120 mg three times a day (by mouth with meals) | Gastrointestinal lipase inhibitor (decreased fat absorption) | Fat malabsorption, flatulence, fecal urgency, oily stools | Pregnancy, fat-soluble vitamin and drug malabsorption (do not use in organ transplant), renal oxalate stones, cholestasis |
| Phentermine/Topiramate-ER | Starting dose 3.75 mg/23 mg every day; treatment dose 7.5 mg/46 mg every day; maximum dose 15 mg/92 mg every day (by mouth) | Sympathomimetic amine (decreases appetite)/anticonvulsant, carbonic anhydrase inhibitor, gabaminergic (increases satiety) | Restlessness, insomnia, headache, dry mouth, tachycardia, BP elevation, paresthesia, dysgeusia, mood changes, mental clouding, blurred vision | Pregnancy, glaucoma, hyperthyroidism, metabolic acidosis, urolithiasis |
| Naltrexone-ER/Bupropion-ER | 8 mg/90 mg tablets; starting dose one tablet every day; treatment dose 2 tablets twice a day (by mouth) | Opioid receptor antagonist (decreases cravings)/dopamine-norepinephrine reuptake inhibitor (decreases appetite) | Nausea, vomiting, diarrhea, constipation, headache, fatigue, insomnia, agitation, mood changes, dry mouth, blurred vison | Pregnancy, seizure risk, uncontrolled hypertension, chronic opioid use |
| Liraglutide 3 mg | Starting dose 0.6 mg/d; maximum dose 3 mg/d (subcutaneous injection) | Glucagon-like peptide-1 receptor agonist (decreases appetite and delays gastric emptying) | Nausea, vomiting, diarrhea, constipation, headache, fatigue | Pregnancy, medullary thyroid cancer, MEN type 2, tachycardia, acute pancreatitis, acute gallbladder disease |
| Semaglutide 2.4 mg | Starting dose 0.25 mg/wk; maximum dose 2.4 mg/wk (subcutaneous injection) | Glucagon-like peptide-1 receptor agonist (decreases appetite and delays gastric emptying) | Nausea, vomiting, diarrhea, constipation, headache, fatigue | Pregnancy, medullary thyroid cancer, MEN type 2, tachycardia, acute pancreatitis, acute gallbladder disease, diabetic retinopathy |
Abbreviations: BP = blood pressure; CNS = central nervous system; ER = extended release; MEN = multiple endocrine neoplasia.
a
Weight-loss drugs should not be used during pregnancy, if planning to become pregnant, and during breastfeeding.
b
15 mg / 30 mg / 37.5 mg phentermine hydrochloride = 12 mg / 24 mg / 30 mg phentermine resin, respectively.