Weight loss medicines

Prescription Weight Loss Drugs

Weight loss medicines

Eating less and moving more are the basics of weight loss that lasts. For some people, prescription weight loss drugs may help.

You'll still need to focus on diet and exercise while taking these drugs, and they're not for everyone.

Doctors usually prescribe them only if your BMI is 30 or higher, or if it's at least 27 and you have a condition that may be related to your weight, type 2 diabetes or high blood pressure.

Here's what you should know about the most common prescription weight loss drugs: liraglutide (Saxenda), naltrexone-bupropion (Contrave), orlistat (Alli, Xenical), phentermine (Adipex-P, Ionamin, Pro-Fast), and phentermine-topiramate (Qsymia).

Before you get a weight loss drug prescription, tell your doctor about your medical history. That includes any allergies or other conditions you have; medicines or supplements you take (even if they're herbal or natural); and whether you're pregnant, breastfeeding, or planning to get pregnant soon.

How it works: Blocks your body from absorbing about a third of the fat you eat.

When a doctor prescribes orlistat, it's called Xenical. If you get it without a prescription, it's called Alli, which has half of Xenical's dose.

Approved for long-term use? Yes.

Side effects include abdominal cramping, passing gas, leaking oily stool, having more bowel movements, and not being able to control bowel movements.

These side effects are generally mild and temporary. But they may get worse if you eat high-fat foods.

Rare cases of severe liver injury have been reported in people taking orlistat, but it's not certain that the drug caused those problems.

What else you should know: You should be on a low-fat diet (less than 30% of your daily calories from fat) before taking orlistat.

Also, take a multivitamin at least 2 hours before or after taking orlistat, because the drug temporarily makes it harder for your body to absorb vitamins A, D, E, and K.

Orlistat is the only drug of its kind that's approved in the U.S. All other prescription weight loss drugs curb your appetite, including the following.

How it works: Contrave is a combination of two FDA-approved drugs, naltrexone and bupropion, in an extended-release formula. Naltrexone is approved to treat alcohol and opioid dependence. Bupropion is approved to treat depression, seasonal affective disorder, and help people stop smoking.

Approved for long-term use? Yes.

Side effects: The most common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, and dry mouth.

Contrave has a boxed warning about the increased risk of suicidal thoughts and behaviors associated with bupropion. The warning also notes that serious neuropsychiatric issues linked to bupropion have been reported.

Contrave can cause seizures and must not be used in patients who have seizure disorders. The drug can also increase blood pressure and heart rate.

What else you should know: If you don't lose 5% of your weight after 12 weeks of taking Contrave, your doctor may tell you to stop taking it, because it's unly to work for you, the FDA says.

How it works: Liraglutide is a higher dose of the type 2 diabetes drug Victoza. It mimics an intestinal hormone that tells the brain your stomach is full.

Approved for long-term use? Yes.

Side effects: Nausea, vomiting, diarrhea, constipation, low blood pressure, and increased appetite. Serious side effects can include raised heart rate, pancreatitis, gallbladder disease, kidney problems, and suicidal thoughts. Liraglutide has been shown in studies to cause thyroid tumors in animals, but it is not yet known if it can cause thyroid cancer in humans.

What else you should know: If you don't lose 4% of your weight after 16 weeks of taking Liraglutide, your doctor may tell you to stop taking it, because it's unly to work for you, the FDA says.

How it works: Curbs your appetite.

Your doctor may prescribe this under the names including Adipex or Suprenza.

Approved for long-term use? No. It's approved for short-term use (a few weeks) only.

Side effects can be serious, such as raising your blood pressure or causing heart palpitations, restlessness, dizziness, tremor, insomnia, shortness of breath, chest pain, and trouble doing activities you've been able to do.Less serious side effects include dry mouth, unpleasant taste, diarrhea, constipation, and vomiting.

As with some other appetite suppressants, there's a risk of becoming dependent upon the drug.

Don't take it late in the evening, as it may cause insomnia.

If you take insulin for diabetes, let your doctor know before you take phentermine, as you may need to adjust your insulin dose.

You should not take phentermine if you have a history of heart disease, stroke, congestive heart failure, or uncontrolled high blood pressure. You also shouldn't take it if you have glaucoma, hyperthyroidism, or a history of drug abuse, or if you are pregnant or nursing.

What else you should know: Phentermine is an amphetamine. Because of the risk of addiction or abuse, such stimulant drugs are “controlled substances,” which means they need a special type of prescription.

How it works: Curbs your appetite.

Qsymia combines phentermine with the seizure/migraine drug topiramate. Topiramate causes weight loss in several ways, including helping you feel full, making foods taste less appealing, and burning more calories.

Approved for long-term use? Yes. Qsymia has much lower amounts of phentermine and topiramate than when these drugs are given alone.

Side effects: The most common side effects are tingling hands and feet, dizziness, altered sense of taste, insomnia, constipation, and dry mouth.

Serious side effects include certain birth defects (cleft lip and cleft palate), faster heart rate, suicidal thoughts or actions, and eye problems that could lead to permanent vision loss if not treated.

Women who might become pregnant should get a pregnancy test before taking Qsymia, and should use birth control and get monthly pregnancy tests while on the drug.

You also shouldn't take Qsymia if you have glaucoma, hyperthyroidism, heart disease, or stroke. Get regular checks of your heart when starting the drug or increasing the dose.

What else you should know: If you don't lose at least 3% of your weight after 12 weeks on Qsymia, the FDA recommends that you stop taking it or that your doctor increase your dose for the next 12 weeks — and if that doesn't work, you should gradually stop taking it.

SOURCES:

National Institute of Diabetes and Digestive and Kidney Disease: “Prescription Medications for the Treatment of Obesity.”

FDA: “FDA Drug Safety Communication: Completed Safety Review of Xenical/Alli (orlistat) and Severe Liver Injury” and “Medications Target Long-Term Weight Control.”

MedlinePlus: “Phentermine.”

News release, FDA.

MedlinePlus.

UpToDate.

Qsymia.com.

novo-pi.com: “Saxenda.”

static.contrave.com: “Contrave.”

© 2020 WebMD, LLC. All rights reserved. What Is Obesity?

Source: https://www.webmd.com/diet/obesity/weight-loss-prescription-weight-loss-medicine

#1 Branded Weight Loss Pills | CONTRAVE (naltrexone HCl/bupropion HCl)

Weight loss medicines

Indication

CONTRAVE is a prescription weight-loss medicine that may help some adults with a body mass index (BMI) of 30 kg/m2 or greater (obese), or adults with a BMI of 27 kg/m2 or greater (overweight) with at least one weight-related medical problem such as high blood pressure, high cholesterol, or type 2 diabetes, lose weight and keep the weight off.

  • CONTRAVE should be used with a reduced-calorie diet and increased physical activity
  • It is not known if CONTRAVE changes your risk of heart problems or stroke or of death due to heart problems or stroke
  • It is not known if CONTRAVE is safe and effective when taken with other prescription, over-the-counter, or herbal weight-loss products

CONTRAVE is not approved to treat depression or other mental illnesses, or to help people quit smoking (smoking cessation).

Please see Full Prescribing Information, including Medication Guide, for CONTRAVE.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

One of the ingredients in CONTRAVE, bupropion, may increase the risk of suicidal thinking in children, adolescents, and young adults.

CONTRAVE patients should be monitored for suicidal thoughts and behaviors. In patients taking bupropion for smoking cessation, serious neuropsychiatric adverse events have been reported.

CONTRAVE is not approved for use in children under the age of 18.

Stop taking CONTRAVE and call a healthcare provider right away if you have any of the following symptoms, especially if they are new, worse, or worry you: thoughts about suicide or dying; attempts to commit suicide; depression; anxiety; feeling agitated or restless; panic attacks; trouble sleeping (insomnia); irritability; aggression, anger, or violence; acting on dangerous impulses; an extreme increase in activity and talking (mania); other unusual changes in behavior or mood.

Do not take CONTRAVE if you have uncontrolled high blood pressure; have or have had seizures; use other medicines that contain bupropion such as WELLBUTRIN, APLENZIN or ZYBAN; have or have had an eating disorder; are dependent on opioid pain medicines or use medicines to help stop taking opioids such as methadone or buprenorphine, or are in opiate withdrawal; drink a lot of alcohol and abruptly stop drinking; are allergic to any of the ingredients in CONTRAVE; or are pregnant or planning to become pregnant.

Before taking CONTRAVE, tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Do not take any other medicines while you are taking CONTRAVE unless your healthcare provider says it is okay.

Tell your healthcare provider about all of your medical conditions including if you have: depression or other mental illnesses; attempted suicide; seizures; head injury; tumor or infection of brain or spine; low blood sugar or low sodium; liver or kidney problems; high blood pressure; heart attack, heart problems, or stroke; eating disorder; drinking a lot of alcohol; prescription medicine or street drug abuse; are 65 or older; diabetes; pregnant; or breastfeeding.

CONTRAVE may cause serious side effects, including:

  • Seizures. There is a risk of having a seizure when you take CONTRAVE. If you have a seizure, stop taking CONTRAVE, tell your healthcare provider right away.
  • Risk of opioid overdose. Do not take large amounts of opioids, including opioid-containing medicines, such as heroin or prescription pain pills, to try to overcome the opioid-blocking effects of naltrexone.
  • Sudden opioid withdrawal. Do not use any type of opioid for at least 7 to 10 days before starting CONTRAVE.
  • Severe allergic reactions. Stop taking CONTRAVE and get medical help immediately if you have any signs and symptoms of severe allergic reactions: rash, itching, hives, fever, swollen lymph glands, painful sores in your mouth or around your eyes, swelling of your lips or tongue, chest pain, or trouble breathing.
  • Increases in blood pressure or heart rate.
  • Liver damage or hepatitis. Stop taking CONTRAVE if you have any symptoms of liver problems: stomach area pain lasting more than a few days, dark urine, yellowing of the whites of your eyes, or tiredness.
  • Manic episodes.
  • Visual problems (angle-closure glaucoma). Signs and symptoms may include: eye pain, changes in vision, swelling or redness in or around the eye.
  • Increased risk of low blood sugar (hypoglycemia) in people with type 2 diabetes mellitus who also take medicines to treat their diabetes (such as insulin or sulfonylureas).

The most common side effects of CONTRAVE include nausea, constipation, headache, vomiting, dizziness, trouble sleeping, dry mouth, and diarrhea.

These are not all the possible side effects of CONTRAVE. Tell your healthcare provider about any side effect that bothers you or does not go away.

Source: https://contrave.com/

Are weight-loss drugs worth trying?

Weight loss medicines
Harvard Women's Health Watch

Image: Bigstock

Newer medications, which may be safer than earlier drugs, have expanded the options for treating obesity.

Obesity is now considered more than a risk factor for other conditions; it's a disease itself. It has been the subject of intense scientific and medical research to develop effective treatments. But the quest has been elusive.

Four medications approved by the FDA since 2012—Qsymia (phentermine and topiramate), Belviq (lorcaserin), Contrave (naltrexone and bupropion ) and Saxenda (liraglutide)—have added to the options for treating obesity, says Dr.

Lee Kaplan, who directs the Obesity, Metabolism, and Nutrition Institute at Harvard-affiliated Massachusetts General Hospital.

“We now have six FDA-approved drugs, but that is a tiny percentage of the number available to treat hypertension and other chronic diseases, so we need even more options to treat obesity most effectively.”

Will the newer drugs help you?

older medications, the new drugs are best used as part of a comprehensive weight-loss program that includes close monitoring by an experienced physician.

The approved drugs are usually prescribed for people with a BMI higher than 30, especially if they have other conditions such as type 2 diabetes, high blood pressure, joint problems, or sleep apnea, which can often be alleviated by losing weight.

Not everyone responds the same way to any given drug. A few people may lose a great deal of weight on a particular drug, while others may lose little or none.

“At present we have no way to predict this response in advance,” Dr. Kaplan says. Fortunately, however, if you don't respond to one drug, you may do well with another.

It often requires trying multiple medications to find the right one for each person.

The weight-loss drugs won't melt off the pounds overnight. When they are successful, they result in an average weight loss of about 5% over a period of six to 12 months. However, even that modest weight loss can improve your health and reduce your risk of heart disease, stroke, and diabetes.

Are weight-loss drugs safe?

You may remember some disturbing reports about previous weight-loss medications. Dexfenfluramine and fenfluramine were taken off the market after they were linked to heart valve damage. Sibutramine (Meridia) was removed after it was linked to heart attack and stroke in people at highest risk for them.

The options on the market today come with their own cautions.

The ingredient phentermine—a component of Adipex-P, Ionamin, and Qsymia—isn't usually recommended for people who have high blood pressure or other heart conditions.

Topiramate, another component of Qsymia, has been linked to an increased risk of birth defects, so women who take it should take special precautions not to get pregnant.

If a drug helps you lose 5% of your weight within a few months without side effects, you will ly want to continue it. But medications are not a substitute for lifestyle changes. They work best when used as part of a broader medical weight-loss program. They should be just one part of a lifelong plan that includes a healthy diet, regular exercise, adequate sleep, and stress reduction.

Some weight-loss medications contain drugs used to treat other conditions. You may want to consider a “dual-purpose” medication if you have the following:
  • Type 2 diabetes. You might want to try liraglutide (Saxenda), which may lower your blood sugar.
  • Migraines. If you're a migraine sufferer and don't intend to get pregnant, you might consider Qsymia. One of its components, topiramate, is approved for treating migraines and seizures.
  • Depression. Contrave contains bupropion, an antidepressant. It may elevate your mood, which can aid weight loss.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Source: https://www.health.harvard.edu/staying-healthy/are-weight-loss-drugs-worth-trying

List of Weight Loss Medications (17 Compared) – Drugs.com

Weight loss medicines

About Weight Loss:  Decrease in existing body weight.

See also: Obesity and sub-topics

The following list of medications are in some way related to, or used in the treatment of this condition.

  • AIDS Related Wasting (8 drugs)
  • Failure to Thrive (1 drug)

The following products are considered to be alternative treatments or natural remedies for Weight Loss. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. However there may be historical, cultural or anecdotal evidence linking their use to the treatment of Weight Loss.

ICD-10 CM Clinical Codes (External)

  • Look up ICD10 codes for Weight Loss on icd-codes.com
Rx OTC Rx/OTC Off Label
Prescription Only
Over the Counter
Prescription or Over the Counter
This medication may not be approved by the FDA for the treatment of this condition.
Pregnancy Category A B C D X N
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.
There is positive evidence of human fetal risk adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use in pregnant women despite potential risks.
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk adverse reaction data from investigational or marketing experience, and the risks involved in use in pregnant women clearly outweigh potential benefits.
FDA has not classified the drug.
Controlled Substances Act (CSA) Schedule N 1 2 3 4 5
Is not subject to the Controlled Substances Act.
Has a high potential for abuse. Has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use under medical supervision.
Has a high potential for abuse. Has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse may lead to severe psychological or physical dependence.
Has a potential for abuse less than those in schedules 1 and 2. Has a currently accepted medical use in treatment in the United States. Abuse may lead to moderate or low physical dependence or high psychological dependence.
Has a low potential for abuse relative to those in schedule 3. It has a currently accepted medical use in treatment in the United States. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 3.
Has a low potential for abuse relative to those in schedule 4. Has a currently accepted medical use in treatment in the United States. Abuse may lead to limited physical dependence or psychological dependence relative to those in schedule 4.
Alcohol X
Interacts with Alcohol.

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Source: https://www.drugs.com/condition/weight-loss.html

Prescription Diet Pills: What Are the Options for Weight Loss?

Weight loss medicines

Medically reviewed by L. Anderson, PharmD Last updated on Apr 13, 2018.

What Are Weight Loss Drugs?

Prescription weight loss pills, also called anti-obesity drugs or “diet pills”, are sometimes prescribed to a patient as an additional tool in the treatment for weight loss. Tools added to medication treatment usually include a plan for lower fat and calorie foods, as well as a regular exercise program.

Most weight loss drugs that suppress the appetite are known as anorexiants. Some weight loss drugs contain a stimulant medication and are classified as controlled substances by the Drug Enforcement Agency (DEA).

In 2012, the FDA approved the first two new weight loss drugs in over a decade — Belviq and Qsymia.

Since that time, several more new weight loss medications have been approved, including Contrave, Saxenda, and Belviq XR.

Patients who are overweight or obese with any health condition should consult with their physician prior to beginning a weight loss or exercise program.

There are very few proven choices in over-the-counter (OTC) or nonprescription medications for effective weight loss. One agent that is available without a prescription is Alli (orlistat), a lower-dose version of the prescription drug Xenical.

Many people who are trying to lose weight may attempt to use dietary supplements or herbal medications, but most of these products have not been adequately studied for effectiveness or safety and none are approved by the U.S. Food and Drug Administration (FDA) for weight loss. Check with a healthcare provider for advice before using herbal or dietary supplements for weight loss.

How Much Weight Can I Lose With Diet Pills?

Prescription weight loss drugs may be an option for patients who have serious health risks, such as high blood pressure, type 2 diabetes, or high cholesterol and cannot control their weight with diet and exercise alone. Weight loss drugs should not be used as a substitute for healthful eating and a regular exercise program.

Over one year, patients using weight loss drugs may lose roughly 5% to 10% of their initial weight when used as part of a diet and exercise plan. However, for most weight loss drugs, if you have not lost at least 5% of your initial body weight after 12 weeks, it is unly that you will achieve and sustain clinically meaningful weight loss with continued treatment.

Common “Diet Pills” or Weight Loss Drugs

Brand Name Generic Name Description Controlled Substance?
Adipex-P Phentermine Appetite suppressant; anorectic Yes, DEA schedule IV
Alli Orlistat Lipase inhibitor; inhibits fat absorption in the intestine No, available over-the-counter (OTC)
Belviq, Belviq XR Lorcaserin Selective serotonin 2C receptor agonist; promotes a feeling of fullness or satiety Yes, DEA schedule IV
Bontril PDM Phendimetrazine Appetite suppressant; anorectic Yes, DEA schedule III
Desoxyn Methamphetamine Appetite suppressant; use cautiously if prescribed for weight loss due to high potential for abuse, illegal distribution Yes, DEA schedule II
Didrex Benzphetamine Appetite suppressant; anorectic Yes, DEA schedule III
Diethylpropion Diethylpropion Appetite suppressant; anorectic Yes,  DEA schedule IV
Meridia Sibutramine Anorectic; withdrawn from US market in 2010 due to increased heart risk. Not available
Qsymia Phentermine and topiramate extended-release capsules. Combination appetite suppressant-anorectic; exact action of topiramate on weight loss is not known Yes, DEA schedule IV
Suprenza Phentermine Appetite suppressant; anorectic Yes, DEA schedule IV
Xenical Orlistat Lipase inhibitor; prescription form of Alli (OTC); higher dose than Alli; inhibits fat absorption in the intestine No
Contrave Bupropion hydrochloride-naltrexone hydrochloride Increases metabolism, suppresses appetite, affects central reward center (proposed mechanism) No
Saxenda Liraglutide GLP-1 may regulate areas of brain involved in appetite (proposed mechanism) No

How Effective Are Weight Loss Drugs?

Weight loss drugs don't always work for everyone. It is usually recommended that one to two pounds of weight can be safely lost per week.

  • Weight loss drugs typically result in a 5% to 10% weight loss over a 12-month period when used as part of a diet and exercise plan.

For a patient weighing 200 pounds, this would translate into losing about 10 to 20 pounds over one year, which would fall within the safe guidelines for weight loss. While this amount of weight loss seems small, it may be enough to help lower blood pressure or have a positive effect on blood sugar.

Who Should Use Weight Loss Drugs?

Generally, most overweight people should initially try to lose weight using diet and exercise. Prescription diet pills are used in more severe circumstances, when weight loss has not been successful and the patient has important health risks associated with being overweight or obese. However, diet and exercise should always be used in conjunction with prescription weight loss drugs.

Most prescription weight loss drugs note in the package labeling that a person should meet certain requirements, such as a specified body mass index (BMI) and/or have a serious medical risk before using the drug.

Weight loss drugs are usually indicated for obese patients with an initial body mass index (BMI) greater than 30 kg/m2 or overweight patients with a BMI greater than 27 kg/m2 in the presence of other risk factors (eg, high blood pressure, type 2 diabetes, high cholesterol).

Examples of serious medical risks include:

To help assess your health risk weight, calculate your body mass index (BMI) here.

Should I Try to Lose Weight If I Am Pregnant?

A certain amount of additional weight gain, and no weight loss, is currently recommended for all pregnant women, including those women already overweight or obese.

Weight loss drugs should not be used during pregnancy. All weight loss drugs fall under pregnancy category X and are contraindicated (meaning do not use) in pregnancy. Weight loss offers no potential benefit and may result in fetal harm during pregnancy. Talk to your doctor about how much weight you should gain during pregnancy, and how quickly.

Sources

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Source: https://www.drugs.com/article/prescription-weight-loss-drugs.html

5 Weight Loss Drugs Approved by FDA | Results & Side Effects

Weight loss medicines

Americans are learning to downsize everything—except food portions. Despite efforts by the medical community and governmental and private organizations, the obesity epidemic seems to be a runaway train. And what’s keeping up with that train? The type 2 diabetes prevalence.

Just as there’s no magic bullet for any big health problem, there’s no magic weight loss capsule. However, over the past four years, the FDA has approved four new drugs for weight loss.

A recent meta-analysis of twenty-eight clinical trials involving over 28,000 participants found that each of the five FDA-approved weight loss drugs was associated with achieving at least five percent weight loss in one year, compared with participants who were given a placebo. Let’s take a look at these drugs.

Orlistat

Brand names: Alli (Orlistat 60 mg) and Xenical (Orlistat 120 mg)

A lipase inhibitor (fat blocker), Orlistat causes less fat (30 percent of fat and calories) to be absorbed into the gut. Side effects include diarrhea from eating fatty foods when taking the medication.

Xenical (Orlistat 120 mg) was approved as a prescription product by the U. S.

Food and Drug Administration (FDA) in 1999 for obesity management, in addition to an over-the-counter version at a smaller dose: Alli (Orlistat 60 mg) was approved in 2007.

In the spring of 2010, the the FDA issued a safety warning about this drug. Some people who take Orlistat are potentially at risk for liver failure. The drug label has been revised to include new safety information about the rare occurrence of severe liver injury.

Cost: Ranges between $120 and $500 per month—contact your local pharmacy to price out the option that is prescribed or suggested to you by your doctor.*

Phentermine and Topiramate

Brand name: Qsymia

This drug combines two FDA-approved medications—phentermine and topiramate—in an extended-release formula. Phentermine helps short-term weight loss, and topiramate (an epilepsy and migraine medicine) triggers satiety. Trial results showed that after a year of taking Qsymia, patients prescribed the highest dose lost, on average, 8.

9 percent of their total body weight, and those taking the recommended dose experienced a 6.7 percent weight loss compared to treatment with a placebo. This drug is not recommended for patients with glaucoma or hyperthyroidism, or for patients who have recently experienced a heart attack or stroke. Because the drug can increase heart rate, regular monitoring is recommended.

Qsymia must not be used during pregnancy.

Cost: approximately $200 per month.*

Lorcaserin Hydrochloride

Brand name: Belviq

This drug works to control appetite and metabolism. It was approved by the FDA in 2012 for adults with a body mass index greater than 30, and for adults with a BMI of 27 or greater who also have high blood pressure, type 2 diabetes, or high cholesterol.

The drug works to stimulate the serotonin 2CV receptor in the brain, which may help patients feel fuller after eating less. In clinical trials, 38 percent of patients (without type 2 diabetes) lost at least 5 percent of their total body weight, compared to 16 percent of patients treated with a placebo.

The FDA reports positive effects in glycemic control for patients with type 2 diabetes. The drug’s negative side effects include migraines. For patients with diabetes, common side effects also include hypoglycemia, headache, back pain, cough, and fatigue.

Memory and attention problems, as well as serotonin syndrome, are other side effects to note.

Cost: approximately $240 per month.*

Naltrexone Hydrochloride and Bupropion Hydrochloride

Brand name: Contrave

This is an extended-release combination of two FDA-approved medications, a known antidepressant and smoking cessation medication (bupropion) and a drug that treats alcohol and opioid addiction (naltrexone). It was approved by the FDA in 2014 for adults with a body mass index greater than thirty, and for adults with a BMI of twenty-seven or greater who also have type 2 diabetes or high cholesterol.

Bupropion is thought to increase dopamine activity in the brain, which helps reduce appetite and increase energy burned. Naltrexone works by blocking opioid receptors.

Potential side effects include nausea, constipation, headache, vomiting, and insomnia, seizures, and suicidal thoughts. This drug can raise blood pressure and heart rate, so it should not be used in those with existing high blood pressure.

Other contraindications include use in individuals who are taking opioids or undergoing treatment for opioid use or alcohol use.

Cost: Can vary from $55 to over $200 per month, depending upon your dose.*

Liraglutide

Brand name: Saxenda

This drug is a glucagon- peptide-1 (GLP-1) receptor agonist, a class that other drugs used to treat diabetes fall into. Saxenda should not be used in conjunction with any other drug in this class, even Victoza, which has the same active ingredient at different doses.

Results from a clinical trial showed that 49 percent of participants treated with Saxenda lost at least 5 percent of their body weight compared to just 16 percent of participants treated with placebo.

The most common side effects are nausea, diarrhea, constipation, vomiting, decreased appetite, and low blood sugar.

Rare but serious side effects include complications with the thyroid, kidney, and pancreas, in addition to suicidal thoughts.

Cost: up to $1,232.*

* Many drug companies have prescription assistance programs that can help you pay for these medications. Cost may vary depending upon your dose and insurance factors. Talk to your doctor and pharmacist about finding an affordable option.

Genentech. “Highlights of Prescribing Information: XENICAL (Orlistat).” 2016. https://www.gene.com/download/pdf/xenical_prescribing.pdf.

U.S. Food and Drug Administration. “Orlistat (Marketed as Alli and Xenical) Information.” July 8, 2015. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm180076.htm.

U.S. Food and Drug Administration. “FDA Approves Weight-Management Drug Contrave.” September 10, 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm413896.htm.

U.S. Food and Drug Administration. “FDA Approves Weight-Management Drug Saxenda.” December 23, 2014. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm427913.htm.

U.S. Food and Drug Administration. “FDA Approves Belviq to Treat Some Overweight or Obese Adults.” June 27, 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm.

U.S. Food and Drug Administration. “FDA Approves Weight-Management Drug Qsymia.” July 17, 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312468.htm.

Updated by Julia Telfer, MPH, 11/16

Source: https://dlife.com/weight-loss-drugs/

Top Weight Loss Medications

Weight loss medicines

July 31, 2018
By Doris Munoz-Mantilla, MD, FOMA

Weight loss medications are an important component of a complete treatment plan for adults with obesity (BMI > 30) or overweight (BMI > 27) with increased adiposity complications. The benefits of weight loss medications include: appetite control, improvement of eating behavior, and slow progression of weight gain and regain.

Before 2012, there were few weight loss medications approved by the U.S. Food and Drug Administration (FDA). The top medications at that time were phentermine and orlistat.

Currently Available Weight Loss Medications

Phentermine (Adipex, Ionamin, Suprenza) and diethylpropion are the oldest medications for weight loss. Phentermine is available in daily doses of 37.5 mg, 30 mg,15 mg, and 8 mg (Lomaira).

Phentermine is FDA-approved for short term use, and it is an adrenergic agonist that produces appetite suppression. Side effects include: dry mouth, insomnia, dizziness, and irritability.

Caution should be used in patients with hypertension.

Orlistat is a weight loss pill that inhibits pancreatic and gastric lipase decreasing fat absorption in the gastrointestinal tract. It is available to be taken with meals in doses of 120 mg (Xenical) and 60 mg (Alli) OTC. Side effects include: flatulence with fatty discharge and fecal urgency after consumption of high-fat foods, side effects that lead to medication discontinuation.

Since 2012, the FDA has approved four safe weight loss medications for long-term weight management.

Lorcaserin (Belviq, Belviq XR) is a selective serotonin 5HT 2c receptor agonist that suppresses appetite. It is well tolerated but has modest weight loss results. Side effects include: headache, nausea, dizziness, euphoria, and impairment of attention-cognition. It is not recommended for patients taking other serotonin-modulating medications or those with known cardiac valvular disease.

Phentermine-Topiramate extended release (Qsymia) is the most effective weight loss drug available to date. It combines an adrenergic agonist with a neurostabilizer. Daily doses with four strengths start at 3.75/23mg to 15mg/92mg. Adults with migraines and obesity are good candidates for this weight loss medication.

Side effects include: abnormal sensations, dizziness, taste alterations, insomnia, constipation, and dry mouth. Contraindications include: uncontrolled hypertension and coronary artery disease, hyperthyroidism, glaucoma, and sensitivity to stimulants.

If more than 5% weight loss is not achieved after 12 weeks of the maximum dose, the weight loss pill should be gradually discontinued.

Bupropion/Naltrexone (Contrave) combines a dopamine/norepinephrine reuptake inhibitor and an opioid receptor antagonist. Start with a daily dose of 8/90 mg tablet to four tablets a day.

It controls cravings and addicted behaviors related to food. Side effects include: constipation, headaches, insomnia, and dry mouth.

Contraindications include: uncontrolled hypertension, history of seizures, and opioid use and dependence.

Liraglutide (Saxenda) is a glucagon- peptide 1 (GLP-1) receptor approved for diabetes type 2 as Victoza and for weight loss injection as Saxenda. Doses start at 0.6 mg to 3 mg a day. Liraglutide delays gastric emptying and causes satiety.

Good candidates are adults with diabetes and prediabetes. Side effects include: nausea, vomiting, diarrhea, constipation, and abdominal pain. It is contraindicated in patients with personal or family history of medullary thyroid carcinoma.

Obesity medications are intended for long-term use, as obesity is a chronic disease. They improve health, quality of life, and body weight in patients with overweight and obesity.

Medications for weight loss are only one component of a comprehensive treatment plan that also includes nutritional, physical activity, and behavioral therapies.

What are the differences between OTC and prescription weight loss medications?

The medicines currently available are appetite suppressants in some form. They help control hunger and cravings, so you can stick to your nutrition and exercise plan. The only FDA-approved over-the-counter medicine for weight loss is Alli (orlistat). This blocks the body’s ability to absorb fats.

The remainder of over-the-counter products are considered supplements. They are not regulated by the FDA and do not have proper studies to confirm their safety and effectiveness. There are prescription medicines that help with weight loss: Belviq (lorcaserine), Qsymia (phentermine/topiramate), Contrave (bupropion/naltrexone), and Saxenda (liraglutide).

These are only available through a prescription from a healthcare provider. Each one has certain indications the medical evaluation. Obesity is a chronic disease that caused by multiple factors and is the leading risk factor for numerous other medical conditions.

Therefore, it is important that your healthcare provider works with you to ensure you are on the safest and most effective medication.

What is the connection between antidepressant medication and weight loss?

Many antidepressants are weight-positive (cause weight gain), some are weight-neutral, and at least one is weight-negative (cause weight loss). When starting an antidepressant, it is a good idea to speak with a healthcare provider about the different options and find a medication that will not cause weight gain.

Antidepressants are broken down into categories: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAO inhibitors), and others. Medications within each of these categories can cause weight gain.

In the SSRI group, Paroxetine shows the highest associated weight gain. Other SSRIs, including Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), and Sertraline (Zoloft), have variable effects on weight, and some do not show weight gain until after six months of use.

Weight-positive medications in the tricyclic antidepressant category include Amitriptyline, Doxepin, and Imipramine. Desipramine, Nortriptyline, and Protriptyline have variable effects on weight. Bupropion (Wellbutrin), an aminoketone, is considered weight-negative and is prescribed both to assist in weight loss and to treat depression.

However, people respond to antidepressants differently. If a person’s depression can be controlled with a weight-negative or weight-neutral antidepressant, they will ly take the medication more consistently, resulting in better efficacy.

Which weight loss medications are known for suppressing appetite?

The following FDA-approved medications suppress appetite: Liraglutide (Saxenda™), Lorcaserin (Belviq™), Naltrexone-Bupropion (Contrave™), Phentermine-Topiramate (Qysmia™), as well as these stimulants: benzphetamine (Didrex™), diethylpropion (Tenuate™), phentermine (Adiphex-P™, ProFast™), and phendimetrazine. Each medicine impacts appetite differently.

Liraglutide is an injectable medication that acts on hormones from the gut that send signals to the brain to make you feel full quicker and decrease hunger signals. Lorcaserin is an oral medication that makes you feel full sooner by acting on serotonin, a neurotransmitter, in a part of the brain that controls appetite.

Naltrexone-bupropion also works in the brain, but on the pleasure-reward areas, to decrease cravings and appetite. Phentermine-topiramate is a combination of two medications that work together to decrease appetite and cravings. Topiramate also alters taste sensation, making food less enjoyable for some. The stimulants all work in the brain to decrease appetite.

All weight loss medications work best in the context of a healthy eating plan and exercise.

References:

  1. Obesity Algorithm. 2017-2018. Obesity Medicine Association
  2. Saunders KH, Shukla AP, Igel LI,  Aronne LJ. Obesity: When to consider medication. The Journal of Family Practice. 2017: 66:608-615.
  3. Diet, Drugs, Devices and Surgery for Weight Management. The Medical Letter, June 4 2018:60 (1548).
  4. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA, 2016: 315(22):2424-2434.

Source: https://obesitymedicine.org/weight-loss-medications/

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