Current FDA approved medications for weight loss:

• Phentermine (Adipex or Lomaira)
• Phentermine/Topiramate (Qsymia)
• Naltrexone HCL/Bupropion (Contrave)
• Liraglutide (Saxenda)
• Semaglutide (Wegovy)
• Tirzeparide (Mounjaro)

Phentermine

Phentermine (brand names: Adipex-P, Lomaira) is a medicine that reduces food intake by causing you to feel full more quickly after eating. Phentermine is classified as a controlled substance by the United States (US) Food and Drug Administration due to its potential for abuse, although the actual observed rate of abuse is extremely low.

In trials ranging from 12 to 36 weeks, patients taking phentermine lost an average of approximately 15 to 17 pounds (7 to 8 kg). Phentermine side effects include an increase in blood pressure and heart rate, insomnia, dry mouth, constipation, and nervousness. You should not take phentermine if you have heart disease, uncontrolled high blood pressure, hyperthyroidism, or a history of drug abuse.

Phentermine is taken once or twice daily, and is intended for short-term use (<12 weeks). If you do not lose at least 5 percent of your initial body weight after 12 weeks, you should stop the medication and discuss alternative options.

If not covered by insurance, phentermine is often available at an affordable cash pay price.

Phentermine-topiramate (Qsymia)

Phentermine and extended-release topiramate are available in combination as a single capsule (brand name: Qsymia). Topiramate is used for the prevention of migraine headaches and to treat seizures in people with epilepsy. People taking topiramate for these indications lose weight, but the way this works is uncertain. People taking this combination medication lose approximately 8 to 10 percent of their initial body weight after one year.

The dose of phentermine-topiramate is usually increased gradually, while weight loss is monitored. If you do not lose 5 percent of your initial body weight after 12 weeks on the highest dose, phentermine-topiramate should be discontinued gradually, as abrupt withdrawal of topiramate can cause seizures.

The most common side effects are dry mouth, constipation, and a “pins and needles” sensation of the skin. There is also a risk of psychiatric (eg, depression, anxiety) and cognitive (eg, disturbance in attention) problems; this risk increases with larger doses of the medication. Although phentermine-topiramate improves blood pressure slightly, it is also associated with an increase in heart rate. Phentermine-topiramate should not be used during pregnancy because of the risk of birth defects. People who could get pregnant should take a pregnancy test before starting this medication (and monthly thereafter) to ensure that they are not pregnant. It should also not be used in people with cardiovascular disease (high blood pressure or coronary heart disease).

If not covered by insurance, Qsymia is available for self-pay patients through a mail order pharmacy for $98 per month.

Bupropion-naltrexone (Contrave)

Bupropion is a medicine that is used to treat depression and to prevent weight gain in people who are trying to quit smoking. Naltrexone is a drug used to treat alcohol and drug dependence. Together they work on two main areas of the brain both the hypothalamus (hunger center) and mesolimbic reward center (cravings) to help you lose weight. People taking combination bupropion-naltrexone (brand name: Contrave) lost approximately 5 to 6 percent of their initial body weight after one year. Common side effects include nausea, headache, constipation, insomnia, vomiting, dizziness, and dry mouth. The dose of bupropion-naltrexone is increased gradually over four weeks. If you do not lose at least 5 percent of your initial body weight after 12 weeks, the medication should be discontinued because benefit is unlikely.

Bupropion-naltrexone should not be used in people with uncontrolled high blood pressure, seizure disorders, or an eating disorder. It should also not be used by people who take (or have recently taken) certain other medications, including those containing bupropion, chronic opioids (narcotics), or monamine oxidase inhibitors. It is also not advised to take this medication with alcohol.

If not covered by insurance, Contrave is available for self-pay patients through a mail order pharmacy for $99 per month.

Liraglutide (Saxenda) or Semaglutide (Wegovy)

These medications are given by injection under the skin in the abdomen, thigh, or upper arm. They are used in the treatment of diabetes and work by increasing insulin release in response to a meal and slowing digestion. They may also have cardiovascular benefits in adults with type 2 diabetes.

In the United States, liraglutide and semaglutide are also approved for the treatment of obesity in people without diabetes. Liraglutide (brand name: Saxenda) is injected once daily, while semaglutide (brand name: Wegovy) is injected once weekly. Both medications are started at a low dose then increased gradually to help minimize side effects such as nausea.

Liraglutide and semaglutide are very effective weight loss medications. In studies evaluating the use of these medications along with lifestyle changes, people lost up to 7 to 16 percent of their body weight when taken for one year or longer; semaglutide appears to induce greater weight loss than liraglutide.

Side effects are common, particularly at higher doses, and may include nausea, vomiting, or diarrhea. You may not be able to tolerate the recommended dose of the medication due to side effects, but it may be recommended to continue to take it at a lower dose if you are losing weight.

These medications should not be taken during pregnancy, if you have a history of pancreatitis, a personal or family history of medullary thyroid cancer, or a personal or family history of multiple endocrine neoplasia. If you have diabetes and take other medications to help control your blood sugar, you will want to monitor your blood sugar closely and may reduce the dose of your other diabetes medications while you are taking these medications.

If not covered by insurance, both Saxenda and Wegovy are often unaffordable as cash pay options. If you are interested in starting these medications, please contact your insurance company to determine coverage.

Tirzepatide (Mounjaro)

Mounjaro is given by injection under the skin in the abdomen, thigh, or upper arm. It is used in the treatment of diabetes and works by enhancing both first and second phase insulin secretion, reducing glucagon levels, improving insulin sensitivity, decreasing food intake, and slowing gastric emptying.

Side effects are common, particularly at higher doses, and may include decreased appetite, nausea, vomiting, diarrhea, constipation, tachycardia, abdominal pain or bloating, GERD, and hypoglycemia. You may not be able to tolerate the recommended dose of the medication due to side effects, but it may be recommended to continue to take it at a lower dose if you are losing weight.

Mounjaro should not be taken during pregnancy, if you have a history of pancreatitis or kidney disease, a personal or family history of medullary thyroid cancer, or a personal or family history of multiple endocrine neoplasia. If you have diabetes and take other medications to help control your blood sugar, they will want to monitor their blood sugar closely and may reduce the dose of your other diabetes medications while you are taking Mounjaro.

Mounjaro may decrease the efficacy of oral hormonal contraception due to changes in gastric emptying. Because the changes in gastric emptying are largest following the first dose, patients using an oral contraceptive should use another method of birth control for 4 weeks after starting treatment and for 4 weeks after each dose increase. Alternatively, you can be switched to non-oral contraceptive methods.