Table 1:

Food and Drug Administration-Approved Medications for Long-term use

	Year approved	Generic Drug	Route of Administration, Frequency and Dose	Mechanism of Action	Wholesale Price per Month*	1-Year Weight Change Relative to Placebo (kg)**
Adults Adolescents age ≥12y	1999 2003	Orlistat	PO, 3 times/day, 60 or 120mg, within 1 hr of fat-containing meals, plus a daily multi-vitamin	Gastrointestinal lipase inhibitor	$300-$600	For nonprescription 60mg TID: −2.5 kg (−1.5 to −3.5) For 120mg TID: −3.4 kg (−3.2 to −3.6) in adults and −2.6 kg in adolescents
Adults only	2012	Phentermine plus topiramate-ER	PO, once daily, start 3.75/23mg /d, then 7.5/46mg/d, escalating to a maximum of 15/92mg/d	Noradrenergic + GABA-receptor activator, kainite/AMPA glutamate receptor inhibitor	$125-$150	For 7.5/46mgd: −6.7 kg (−5.9 to −7.5) For 15/92mg/d: −8.9 kg (−8.3 to −9.4)
Adults only	2014	Naltrexone-bupropion-ER	PO, once or twice daily; start 8-mg naltrexone/90-mg bupropion tablet per day escalating to a maximum of two 8-mg/90-mg tablets twice daily, for a total daily dose of 32 mg/360 mg	Opioid receptor antagonist + dopamine/norepinephrine reuptake inhibitor	$200	−4.9 kg (−4.6 to −5.1)
Adults and adolescents age ≥12y	2014 2020	Liraglutide	SQ, once daily, start 0.6 mg, increase weekly by 0.6 mg to a maximum of 3 mg	GLP1 receptor agonist	$1,500	For adults: −5.2 kg (−4.9 to −5.6) For adolescents: −4.5 kg (−7.2 to −1.8)
Adults only	2021	Semaglutide	SQ, once-weekly, start 0.25 mg escalating to a maximum of 2.4 mg	GLP1 receptor agonist	N/A	−6.1kg to −12.7kg

Weight Loss Medications. GABA: gamma-aminobutyric acid, GLP1: glucagon-like peptide 1, SQ: subcutaneous injection. NA: Not available

^*Reference prices found in February and March 2021.

^**Weight changes relative to placebo (95 percentile confidence interval) using intent-to-treat analyses for each medication at 1 year for orlistat, phentermine-topiramate, naltrexone-bupropion-ER and liraglutide are found in prior reports that performed meta-analyses.^1-3 At present there is only 1 large, placebo-controlled trial for adolescents using liraglutide.⁵ Semaglutide weight change is described in the papers as occurring at week 68, after 52 weeks at full dose.^6-8 Total weight losses (not relative to placebo) are somewhat greater and generally reflect the intensity of the lifestyle modification program offered.