Table 1.
FDA-approved antiobesity medications
| Drug (Brand Name) | Mechanism of Action | Common Adverse Effects | Kidney-Related Precautions | Dosing Adjustments by eGFR, ml/min per 1.73 m2 | |
|---|---|---|---|---|---|
| Stage 3–5 CKD | ESKD | ||||
| Orlistat (Xenical, Alli) | Lipase inhibitor, thus inhibiting absorption | Fecal incontinence, oily spotting, fat-soluble vitamin deficiency | Reports of AKI and chronic kidney injury possibly from oxalate nephropathy | None | None |
| Phentermine (Adipex-P, Lomaira) | Sympathomimetic, anorexic | Hypertension, ischemia, palpitations, dry mouth, constipation | Excreted primarily via the urine | 15–29: maximum 15 g/d | <15: avoid use (not been studied) |
| Phentermine/Topiramate (Qsymia) | Sympathomimetic, anorexic | Tachycardia, paresthesias, dry mouth, constipation, paresthesias, proximal (type 2) renal tubular acidosis, upper respiratory infections | Excreted primarily via the urine | CrCl<50 ml/min: maximum dose 7.5/46 mg once daily | Dialysis: avoid use (not been studied) |
| Buproprion-Naltrexone (Contrave) | Inhibits NE/dodopamine uptake, opioid antagonist | Nausea, constipation, dry mouth, dizziness, transient increase in BP, contraindicated in uncontrolled hypertension | Excreted primarily via the urine | “Moderate or severe impairment”: one tablet (8/90 mg) twice daily | Not recommended |
| Liraglutide (Saxenda) | GLP-1 agonist | Nausea/vomiting, diarrhea, anorexia | None | Use with caution in severe impairment—limited data available | Use with caution due to limited data |
CrCl, creatinine clearance; NE, norepinephrine; GLP-1, glucagon-like peptide-1.