Table 2.
Pharmacological Actions and Efficacy of Currently Approved Medications for Long-Term Treatment of Obesity [summarized from Yanovski and Yanovski. JAMA 2014;311:74-86 (58); Astrup et al. Lancet 2009;374:1606–16 (59); and Pi-Sunyer et al. NEJM 2015:373:11-22 (60)]
| DRUG | Mechanism of action | Dose | Weight loss (kg) vs. placebo |
Adverse effects |
|---|---|---|---|---|
| Orlistat 60 mg (Alli®) or 120 mg (Xenical®; 3× within 1 hour of a fat- containing meal) |
Lipase inhibitor causing excretion of ~30% of ingested triglycerides in stool |
60mg or 120mg, with 3 meals |
60mg dose: −2.5 (−1.5 to −3.5) 120mg dose: −3.4 (−3.2 to −3.6) |
Oily spotting, flatus, fecal urgency, fatty oily stool, increased defecation, fecal incontinence |
| Phentermine plus topiramate- ER (Qsymia®; 3.75mg/ 23mg for 2 weeks, increased to 7.5mg/46mg |
Noradrenergic + GABA- receptor activator, kainite /AMPA glutamate receptor inhibitor causing appetite suppression |
3.75mg/23mg to 7.5mg/46mg; once daily |
7.5mg/46mg: −6.7 (−5.9 to −7.5) 15mg/92mg: −8.9(−8.3 to −9.4) |
Paresthesia, dizziness, taste alterations, insomnia, constipation, dry mouth, elevation in heart rate, memory or cognitive changes |
| Lorcaserin (Belviq®; 10mg, 2×) |
Highly selective serotonergic 5-HT2C receptor agonist causing appetite suppression |
10mg twice daily |
−3.2 (−2.7 to −3.8) |
Headache, dizziness, fatigue, nausea, dry mouth, cough, and constipation; and in T2DM back pain, cough, and hypoglycemia |
| Bupropion SR/ Naltrexone SR (Contrave®) |
Dopamine/norepinephrine reuptake inhibitor and opioid receptor antagonist |
360/32mg p.o. daily |
5-6 % | Headache, nausea, insomnia, constipation tremor |
| Liraglutide, 1.2mg escalating over 4 weeks to 3.0mg SQ (Saxenda ®) |
Glucagon-like peptide 1 agonist causing appetite suppression and possibly delaying gastric emptying |
1.2mg escalating to 3.0mg SQ once daily |
1.2mg dose: −2·1 (0·6– 3·6) 1.8mg dose: −2·8 (−4·3 to −1·3) 2.4mg dose: −3·5‡ (−5·0 to −2·0) 3mg dose: −4·4 (2·9– 60) |
Nausea and vomiting |