Top Weight Loss Medications

The use of medications to treat obesity is becoming more popular. The FDA had only approved a small number of weight-loss drugs before 2012. Orlistat, sold under the brands Xenical and Alli, and phentermine, sold under the brands Lomaira and Adipex-P, were the most popular drugs at the time.

The introduction of agonists that block the glucagon-like peptide-1 receptor (GLP-1 receptor), such as Wegovy and Ozempic, has garnered a lot of media attention. Prescriptions for GLP-1 receptor agonists are increasing in sync with online searches, per a 2022 study published in Frontiers in Cardiovascular Medicine.

Patients may wonder which prescription weight reduction drug is the strongest or most successful now that there is a greater variety of options accessible. The solution is not straightforward. Selecting the appropriate prescription for a given person is not always simple. It’s crucial to stay up to date with the available solutions and their advantages and disadvantages because the market is changing quickly.

Recommendations for Composing Weight Loss Drug Prescriptions:

BMI is the first metric used to determine a person’s suitability for weight loss drugs. People with a BMI of 30 or higher—or a BMI of 27 or higher if they have weight-related medical conditions—are often given the majority of drugs.

In November 2023, Zepbound was authorized for use by people with a body mass index (BMI) of 30 or higher. The patient and the physician should talk about the patient’s current health conditions, other prescription drugs, and family medical history in each situation. The choice will also be influenced by the cost and adverse effects of the medication.

The FDA only permits a few weight-loss medications for adults, but semaglutide, liraglutide, and orlistat are permitted for children 12 years of age and older. It is not recommended to take any of the drugs covered here while pregnant.

Presently Available Drugs for Weight Loss

Some drugs for weight loss have been available for a long time, and new ones are constantly being developed. Typical prescriptions for weight loss drugs include:

Semaglutide (Wegovy, Ozempic)

The GLP-1 receptor agonist semaglutide is sold under the brand name Wegovy. The FDA approved it in 2021. The injection is approved for use in adults and children aged 12 and up who are obese (BMI = 30 for adults, BMI = 95th percentile for children by age and sex), and individuals who have health problems due to their weight and are overweight (BMI ≥ 27).To reach the 2.4 mg dosage, the dose must be increased gradually over 16–20 weeks. This approach can help reduce side effects, including headaches, fatigue, dizziness, and gastrointestinal issues.

The same drug, Ozempic, has a license to treat type 2 diabetes.

Tirzepatide (Zepbound, Mounjaro)

Tirzepatide used to be a Mounjaro medication approved for the treatment of type 2 diabetes. Zepbound is authorized to treat obesity in individuals who have a body mass index (BMI) of 30 or more.

It functions by decreasing hunger and, like semaglutide, is a GLP-1 and GIP receptor agonist. It is intended to be taken in conjunction with diet and exercise to help people lose weight. Additionally, it is given as an injection.

Liraglutide (Saxenda)

A daily injectable drug called liraglutide lowers hunger signals and increases feelings of fullness by influencing gut hormones that communicate to the brain. The first doses are between 0.6 and 3 mg per day. Some people may lose 5–10% of their body weight when taking the increased dose of liraglutide.

Abdominal pain, elevated lipase, nausea, diarrhea, constipation, vomiting, headache, decreased appetite, dyspepsia, exhaustion, disorientation, and renal insufficiency are some of the adverse effects. Patients with a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia Syndrome type 2 should not use it.

Phentermine (Adipex, Suprenza)

Phentermine is the most well-known and conventional weight-loss medication. It was first prescribed as a short-term drug to help people lose weight, but more recent medical guidelines have included it in long-term treatment. When using phentermine, some people may have a 5% reduction in body weight.

The HCl version of phentermine, which comes in dosages of 15 mg and 30 mg, is essentially the only form of the medication that is sold in the US. Overstimulation, headache, tremor, sleeplessness, high blood pressure, and an erratic or fast heartbeat are some of the adverse effects.

Monoamine oxidase (MAO) inhibitors, sympathomimetics, alcohol, adrenergic neuron-blocking medications, and maybe some anesthetics can all cause interactions during or within 14 days after use.

Phentermine-topiramate (Qsymia)

Combining topiramate with phentermine can reduce cravings and appetite. When two medications are taken together, efficacy is increased.

This weight-loss drug works well for adults who are obese and suffer from migraines. An average of 5–10% of body weight may be lost by certain patients.

If you do not lose more than 5% of your body weight after 12 weeks at the highest dosage, you should gradually cease using the weight loss tablet.

For all four strengths, the daily doses vary from 3.75 mg/23 mg to 15 mg/92 mg. Dizziness, altered taste, constipation, dry mouth, sleeplessness, and strange sensations are some of the side effects. Glaucoma, hyperthyroidism, uncontrolled hypertension, coronary artery disease, and stimulant sensitivity are a few of the contraindications.

Naltrexone-bupropion (Contrave)

An opioid receptor antagonist and an antidepressant are combined in naltrexone-bupropion to influence the brain’s pleasure-reward regions, which reduces appetite and cravings. A patient may see a 5–10% decrease in body weight.

One 8/90 mg tablet per day should be used at first, and then four tablets per day. Constipation, headache, nausea, dizziness, sleeplessness, dry mouth, diarrhea, and vomiting are among the most frequent adverse effects. Patients who take opioids for chronic pain or who have seizure disorders shouldn’t be prescribed this drug.

Setmelanotide (Imcivree)

Melanotide is a melanocortin-4 receptor agonist that is prescribed for the long-term control of weight in adults and children aged 6 and up who are obese as a result of one of several uncommon genetic illnesses.

Genetic testing that identifies alterations in the POMC, PCSK1, or LEPR genes classified as pathogenic, probably pathogenic, or of a variation of unknown significance (VUS) is required to confirm the condition.

Orlistat (Xenical and Alli)

Orlistat is a lipase inhibitor that is taken as a capsule and functions by preventing the breakdown of fats that are ingested through meals. In this way, it stops dietary fats from being absorbed.

The body then passes the fat that hasn’t been processed via it. It is recommended to lower the risk of weight regain and is typically used in conjunction with a lower-calorie diet.

A 5% reduction in body weight is possible for certain patients. Take one 120 mg capsule three times a day with a large, fat-containing meal, either during or up to an hour after the meal.

A 60 mg pill of an over-the-counter version is included with every meal that contains fat. Fecal incontinence, increased defecation, flatus with discharge, and greasy rectum discharge are the most frequent side effects of orlistat.

Hydrogel (Plenity)

For those with a BMI between 24 and 40, Plenity, a medical device rather than a drug, received FDA approval in 2019. The growth of GLP-1 receptor agonists has led to a greater media focus on the treatment.

A biodegradable, highly absorbent hydrogel is released into the stomach through a capsule. By increasing fullness, the gel helps the user eat less. Real-world research shows that weight loss averages 9%.

The most recent edition of the Obesity Algorithm®, published by the Obesity Medicine Association, covers each of the aforementioned weight loss drugs in further detail.

Upcoming Weight Loss Medications

In the upcoming years, more drugs will undoubtedly hit the market due to the strong consumer demand for weight loss drugs and the growing prevalence of obesity.

Lilly is creating orforglipron, an oral GLP-1 inhibitor. Another injectable that targets GIP, GLP-1, and glucagon is retributive. Two GLP-1 inhibitors that can be taken as pills are also being developed by Pfizer. Instead of using a dual agonist like semaglutide, Amgen is testing a medication candidate that inhibits the GIP receptor and agonists the GLP-1 receptor.

To find other approaches to treat obesity with medication, researchers are still looking for hormones that affect hunger, such as peptide YY.

In 2021, Endocrine News had an interview with Robert Kushner, MD, a professor at Northwestern University Feinberg School of Medicine. By providing patients and healthcare professionals with a variety of options, he appreciated “The new approach to treating obesity is to treat it more like an endocrine disease, giving patients the freedom to select the appropriate medication and “treating it hormonally.”

A further “hot” class of drugs being developed for a variety of illnesses, including obesity, are monoclonal antibodies. The monoclonal antibody bimagrumab, for instance, is being researched as an infusion to reduce fat and enhance muscle mass.

With more choices, physicians will be able to match patients with the right meds, allowing them to customize treatments more and more. Students interested in learning more about these new options should enroll in OMA’s Future Advances in Anti-Obesity Medications course.

Frequently Asked Questions About Weight Loss Medications

How effective are weight loss medications?

Safe, evidence-based treatments that target particular physiologies to improve the condition, FDA-approved anti-obesity drugs (AOMs) work best when taken as part of an all-encompassing treatment strategy. A person’s weight loss is influenced by their medication, general health, and other personal circumstances.

Despite the increasing selection of weight loss medications, some have been removed due to safety concerns and ineffectiveness.

What is the strongest weight loss prescription medication?

According to clinical research, semaglutide can result in a considerable amount of weight loss. Weight decrease was 5.9% at three months and 10.9% after six months in a 2022 trial with 175 individuals. A larger research published in the New England Journal of Medicine found that the average loss was significantly higher, at 14.9%. The long-term to indefinite duration of treatment, adverse effects, and high cost are semaglutide’s disadvantages.

One medicine may work better for a person than another, as is the case with all obesity treatments. Each individual needs to work with their physician to determine the best course of action for them.

Guidelines for weight reduction drugs were published by the American Gastroenterological Association in 2022 for obese individuals who do not improve with lifestyle changes alone. They provided four possibilities for the opening line:

• Semaglutide
• Liraglutide
• Phentermine-topiramate extended-release (ER)
• Naltrexone-bupropion extended-release (ER)

They also recommended phentermine and diethylpropion. Keep in mind that these suggestions were offered before Zepbound’s approval.

How do weight loss medications work?

By controlling hormones in the brain, digestive tract, and adipose tissue, they mainly reduce hunger and cravings and encourage fullness.

Some medications are administered subcutaneously, while others are taken orally.GLP-1 RAs are often referred to when patients inquire about the differences between injections and weight-loss medications. The effectiveness of pills and injections is roughly comparable, according to data that Novo Nordisk and Pfizer separately revealed in May 2023.

Are there medications that can cause weight gain?

Numerous medications have the potential to make people heavier or more obese. For some people, taking medicines may result in varying amounts of weight gain.

• Some beta-blockers and calcium channel blockers
• Anti-diabetic drugs, including meglitinides, thiazolidinediones, sulfonylureas, and insulins
• Hormone treatments such as injectable progestins and glucocorticoids
• Anti-seizure medications such carbamazepine, gabapentin, valproate, and pregabalin
• A wide variety of different antidepressants
• Some mood stabilizers
• Migraine medications such as amitriptyline and paroxetine
• Some antipsychotics
• Chemotherapeutic and anti-inflammatory agents

How should drugs for weight reduction be used with other types of therapy?

Diabetes can be treated with a variety of methods, such as diet, exercise, medication, and/or surgery. Every medicine for weight loss is most effective when used in conjunction with exercise and a nutritious diet. Drugs can help with hunger, cravings, and metabolic preservation even when a patient is exercising and making other lifestyle changes.

For how long is it advised to take weight-loss medications?

There are drugs for managing weight that are intended for long-term use and others for short-term use. The FDA, for instance, has authorized some for a maximum of 12 weeks.

Tirzepatide (Zepbound, Mounjaro), naltrexone-bupropion (Contrave), phentermine-topiramate (Qsymia), liraglutide (Saxenda), semaglutide (Wegovy, Ozempic), and orlistat (Xenical, Alli) are a few of these.

There may be a lengthy ramp-up phase of up to five months for some of them. Remember that obesity is an illness that cannot be “cured” by medication.

In what ways have the alternatives for weight loss drugs evolved in the last few years?

Despite making a lot of news, GLP-1 RAs are just the most recent in a long line of developing weight-loss drugs. According to a Life Science publication from 2022,

With the discovery of novel physiological processes for weight gain, medications that target these receptors and/or enzymes have been developed. These drugs have less negative psychological effects and higher safety records. Furthermore, medications that target satiety or hunger signaling have been the subject of extensive research and have seen a rise in physician use. Research has also examined medications that target metabolic tissues, including muscle or adipose tissue, to aid in weight loss, but nothing has been implemented in clinical settings as of yet.

Without a doubt, more candidates will be created and some will be released.

How much do the various types of weight-loss drugs cost in comparison?

Certain weight-loss treatments, like all medications, have been around for a while, have generic versions, and are typically less expensive. RAs for GLP-1 are infamously expensive. According to the Kaiser Family Foundation, the projected net cost of Wegovy is $13,600 per year. You can get phentermine for as little as $10, according to GoodRx.

Many patients’ decisions to start using weight reduction drugs will be influenced by the variations in insurance coverage. Medication for weight loss is not covered by Medicare.

How do they affect weight regain?

AOMs have the potential to mitigate the consequences of metabolic adaptation and avert weight loss. Weight regain may result from the metabolic changes brought on by the body’s adaptation to weight loss, which frequently results in an increase in hunger hormones and a decrease in satiety hormones and resting metabolic rate.

Anti-obesity drugs should be continued for weight loss maintenance if the patient reaches a clinically significant weight loss and both the patient and the doctor believe the drug is preventing weight gain. In this case, a weight loss plateau should not be regarded as a reason to stop taking the drug.

What distinguishes prescription and over-the-counter weight loss drugs?

Only one over-the-counter weight-loss medication, Alli (orlistat), has been approved by the FDA thus far. Additional over-the-counter items are categorized as supplements. The FDA does not regulate them, and there are no adequate studies to support their efficacy and safety.

In addition to monitoring progress and side effects, a healthcare provider can assess all factors influencing a patient’s lifestyle and body mass index while prescribing drugs. This association may enable dose adjustments or the usage of different drugs if one medication appears to be a better fit for the patient.

What link exists between weight reduction and depression medication?

At least one antidepressant is weight-negative, meaning it causes weight loss, whereas several are weight-positive, meaning they cause weight gain.

Tricyclic antidepressants, monoamine oxidase inhibitors (MAO inhibitors), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other types of antidepressants are classified into several groups. Medication side effects in each of these categories include weight gain.

The most significant weight increase is linked to paroxetine in the SSRI group. Other SSRIs that affect weight in different ways include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), and Sertraline (Zoloft); some do not show weight increase until six months into their therapy.

Amitriptyline, Doxepin, and Imipramine are weight-positive drugs that fall under the tricyclic antidepressant category. Weight is impacted differentially by desipramine, protriptyline, and nortriptyline.

The aminoketone bupropion (Wellbutrin), which is regarded as weight-negative, is recommended to treat depression and aid in weight loss. People react differently to antidepressants, though.

Which diet pills have a reputation for reducing appetite?

FDA-approved appetite suppressants include benzphetamine (DidrexTM), diethylpropion (TenuateTM), phentermine (Adipex-P, ProFast), phendimetrazine, liraglutide (Saxenda), naltrexone-bupropion (Contrave), and phentermine-topiramate (Qysmia). A medicine’s effect on hunger varies.