Table 13.

Pharmacological options for weight management

Medication	Orlistat	Liraglutide (3 mg)	Semaglutide 2.4 mg	Naltrexone/bupropion	Phentermine/topiramate 3.75 mg/23 mg and 15 mg/92 mg
Mechanism of action	Lipase inhibitor	GLP1 receptor agonist	GLP1 receptor agonist	Naltrexone: opioid antagonist; Buprepion: dopamine and noradrenaline reuptake inhibitors	Phenteramine: noradrenergic sympathomimetic drug; Topiramate: GABA receptor modulation
Weight loss percentage of change (from baseline to 1 year)	4-8.8	6.2-8 7.4% Placebo 3.0%	4.8-13.8 16.9% Placebo 2.4%	6-6.5 5.4%/8.1%* Placebo: 1.3%/4.9%*	5-14.4 5.1%/10.9%† Placebo 1.6%
CV effects	Improvements in CV risk factors: blood pressure and serum lipid levels	Safety data from Liraglutide 1.2 and 1.8 mg CVOT LEADER has been added to label	Safety data from SUSTAIN 6 and PIONEER 6 has established CV safety	Not established	Not established
Dosing	Thrice daily	Daily injection	Weekly once injection Oral semaglutide 3 mg, 7 mg and 14 mg are currently available in India for management of type-2 diabetes mellitus. However oral semaglutide is not approved for obesity management.	Twice daily, oral	Once daily, oral
Common AEs	Oily spotting, flatus with discharge, fecal urgency fatty/oily stool, oily evacuation, increased defecation and fecal incontinence	Nausea, hypoglycemia, diarrhea, constipation, vomiting, headache, dyspepsia, fatigue, dizziness, abdominal pain	Nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dyspepsia, dizziness, abdominal distension	Nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, diarrhea	Paresthesia, dizziness, dysgeusia, insomnia, constipation, dry mouth
Approval status in India	Approved	Not approved for obesity indication	Injectable semaglutide (2021)	Not approved	Not approved