Table 2.

Summary of medications for weight loss in the pediatric population

Drug name	Mechanism of action	FDA indication	Off-label drug use	Consideration
Orlistat61,62	Pancreatic and gastric lipase inhibitor	Obesity, ≥ 12 years of age	Not indicated	Flatulence, oily spotty stools, diarrhea, vitamin/ mineral deficiency
Phentermine63	Sympathomimetic amine	Obesity, > 16 years of age for “short term” use	< 16 Years of age or long term; beneficial in obesity with low-energy states, sleep apnea, hunger, decreased satiety	Increases heart rate, blood pressure, dry mouth, insomnia, constipation, anxiety, and irritability
Metformin65	Activation of protein kinase pathway	≥ 10 years of age, T2DM	PCOS, insulin resistance, prediabetes, metabolic syndrome, antipsychotic medication-induced weight gain, stress eating/emotional eating	Bloating, diarrhea, flatulence; contraindicated with risk of lactic acidosis
Exenatide66-68	GLP-1 agonist	T2DM in adults	< 18 Years of age for obesity (polygenic with the presence of diabetes, hypothalamic, syndromic)	Bloating, nausea/vomiting, abdominal pain, elevation of pancreatic amylase and lipase; contraindicated with history or family history of medullary thyroid carcinoma, MEN type 2, ESRD
Liraglutide69	GLP-1 agonist	3.0-mg liraglutide approved for obesity in adolescents (12–17 years) with a reduced-calorie diet and increased physical activity	Not indicated	GI abdominal pain, nausea, vomiting, diarrhea, potential hypoglycemia; contraindicated with history or family history of medullary thyroid carcinoma, MEN type 2, ESRD

FDA, Food and Drug Administration; T2DM, type 2 diabetes mellitus; PCOS, polycystic ovary syndrome; GLP-1, glucagon-like peptide-1; MEN, multiple endocrine neoplasia; ESRD, end-stage renal disease; GI, gastrointestinal.