Table 2.
Currently used anti-obesity medications: long-term use
| Drug | Action mechanism | Dosage | Adverse effect | Contraindication | DEA schedule |
|---|---|---|---|---|---|
| Orlistat | A reversible gastric and pancreatic lipase inhibitor that reduces the absorption of dietary fat | 120 mg tid | Steatorrhea, fecal urgency, incontinence, flatulence, oily spotting, frequent bowel movements, abdominal pain, headache, severe liver injury, cholelithiasis, malabsorption of fat-soluble vitamin | Pregnancy, breastfeeding, chronic malabsorption syndrome, cholestasis, oxalate nephrolithiasis | None |
| Lorcaserin* (Belviq) | 5-HT2C receptor agonist | 10 mg qd or bid | Headache, nausea, dizziness, fatigue, xerostomia, dry eye, constipation, diarrhea, back pain, nasopharyngitis, hyperprolactinemia, uncontrolled mood disorder, cognitive impairment, leukopenia | Pregnancy, breastfeeding, serotonin syndrome or neuroleptic malignant syndrome | IV |
| Naltrexone/bupropion (Contrave) | Opioid antagonist/dopamine and norepinephrine reuptake inhibitor | 8/90 mg qd-2T bid | Nausea, headache, insomnia, vomiting, constipation, diarrhea, dizziness, anxiety, xerostomia, cardiac arrhythmia, narrow-angle glaucoma, uncontrolled migraine disorder, generalized anxiety disorder, bipolar disorder, seizures (bupropion lowers seizure threshold) | Pregnancy, breastfeeding, uncontrolled hypertension, seizure disorder, anorexia nervosa, bulimia nervosa, severe depression, drug or alcohol withdrawal, concomitant MAOI (within 14 days), chronic opioid use | None |
| Liraglutide 3 mg (Saxenda) | GLP-1 analog | 0.6–3.0 mg/day | Nausea, vomiting, diarrhea, constipation, headache, dyspepsia, increased heart rate, gastroparesis, pancreatitis, cholelithiasis, suicidal ideation and behavior, injection site reactions | Pregnancy, breastfeeding, personal or family history of medullary thyroid cancer or MEN2, pancreatitis, acute gallbladder disease | None |
| Phentermine/topiramate (Qsymia) | Sympathomimetic amine/antiepileptic drug | 3.75/23–15/92 mg qd | Headache, paresthesia, insomnia, decreased bicarbonate, xerostomia, constipation, anxiety, depression, cognitive impairment, dizziness, nausea, dysgeusia, tachyarrhythmia, seizure disorder, anxiety and panic attacks, nephrolithiasis, hyperchloremic metabolic acidosis, abuse potential | Pregnancy, breastfeeding (topiramate teratogenicity), hyperthyroidism, acute angle-closure glaucoma, concomitant MAOI use (within 14 days) | IV |
*Lorcaserin withdrawn from market due to cancer risk.
DEA, Drug Enforcement Agency; tid, three times a day; HT, hydroxytryptamine; qd, once a day; bid, twice a day; MAOI, monoamine oxidase inhibitor; GLP-1, glucagon-like peptide-1; MEN2, multiple endocrine neoplasia type 2.