Table 1:

Summary of medications used for the treatment of pediatric obesity.

Medication	Mechanism	Side effects	Contraindications	Efficacy from Pediatric data (different measures of weight change reported)
Orlistat13,18,19,78	Inhibits pancreatic and gastric lipase Decreases lipid absorption	GI symptoms -abdominal pain, oily stools and spotting, fecal urgency & incontinence, flatus, fat soluble vitamin deficiency	Chronic malabsorption, cholestasis, pregnancy	−2.61-kg placebo-subtracted weight loss after 1 year of treatment.
Phentermine14,22,28	Norepinephrine reuptake inhibitor Inhibits hypothalamic catecholamine release	Irritability, insomnia, dry mouth, dizziness, tremor, headache, HR and BP elevation. GI symptoms- abdominal pain, diarrhea, constipation, nausea	Cardiovascular disease, hyperthyroidism, glaucoma, co-use of monoamine oxidase inhibitors	4.1% reduction in BMI and 3.2 kg reduction in weight at 6-months with phentermine and lifestyle modification compared to lifestyle modification only
*Topiramate15,26,29,79	Augments the GABA (A) activity Blocks neuronal Na channels Antagonizes glutamate receptors Weakly inhibits carbonic anhydrase	Cognitive dysfunction, paresthesia, nephrolithiasis, metabolic acidosis	Pregnancy (teratogen), acute myopia and secondary angleclosure glaucoma	2 – 4.9% BMI reduction with 75 mg of topiramate for 6 months
*Bupropion/Naltrexone24,32,33,80	Bupropion selectively inhibits reuptake of dopamine and noradrenaline Naltrexone is an opioid receptor	Headache, dizziness, vomiting, constipation, dry mouth. irritability, dizziness, insomnia, headaches, anxiety, fatigue and tremor	A black box warning of increased suicidal risk and ideation in young adults	Data is not available for < 18 years
*Metformin26,36,78	Biguanide, interferes with protein kinase signaling, thus suppressing glucose production in the liver and its absorption from the intestine Increase glucose uptake in the periphery	Mostly GI symptoms- bloating, flatus, diarrhea, usually well tolerated	Severe Hepatic/Renal Disease	BMI Z score reduction of 0.1 and BMI reduction of 0.86 compared to placebo
*Lis dexamphetamine40,41	Dopamine agonist CNS stimulator	Diarrhea, dizziness, dry mouth, irritability, insomnia, nausea, abdominal pain, vomiting, HR and BP elevation	Cardiovascular diseases Psychiatric adverse reactions Serotonin syndrome with use of serotonergic agent.	0.24–0.51-point reduction in BMI z score (dose dependent)
*GLP-1 agonists17,26,47–49,55,57–59,81,82 Exenatide Liraglutide	Enhance insulin secretion Slowing gastric emptying Act on the hypothalamus, limbic/reward system and cortex	GI symptoms- nausea, vomiting, diarrhea Hypoglycemia risk in those on insulinotropic medications A small risk of cholelithiasis and pancreatitis	Pregnancy, personal or family history of medullary thyroid carcinoma or type 2 multiple endocrine neoplasia	Absolute BMI reduction of 3.42% with exenatide for 3–6 months BMI SDS reduction of 0.23 with 56 weeks of Liraglutide vs placebo

GI, gastrointestinal; HR, heart rate; BP, blood pressure; BMI, body mass index; GABA, gamma-Aminobutyric acid; CNS, central nervous system; GLP-1, glucagon-like peptide 1; SDS, standard deviation score;

^*Non-FDA- approved medications for indication of weight loss (off label use)