Pharmacotherapy for obesity
Obesity is a serious, chronic, relapsing disease of energy regulation, with strong genetic and early-life environmental determinants.
Medications can be useful adjunct to lifestyle intervention in effecting and maintaining clinically significant weight loss in those with BMI >30, or 27-30 and obesity-related complications.
*Check BMI here.
Safety and efficacy should be monitored closely on commencement and the medication should be discontinued if there are safety or tolerability issues, or if <5% weight loss is observed after 3-4 months
For the majority of patients, following the exemplary diet and exercise recommendation provide only modest or no weight loss and difficulty to sustain.
|Drug||Starting dose||Available doses||Weight loss vs placebo (% or kg)||Side Effects||Contraindications|
|Phentermine||15 mg||15, 30, 40 mg||3.6-4.5 kg in 6 months||Insomnia, dry mouth, agitation, tachicardia||Hypertension, glaucoma, history drug/alcohol abuse, SSRI antidepressants, pregnancy, heart disease|
|Orlistat||120 mg TDS||120 mg||2.9-3.4% in 1 year||Steatorrhea, oil spotting, flatulence, incontinence, vitamin malabsorption||pregnancy|
|Liraglutide||0.6 mg||0.6 – 3||5.4% in 1 year||Nausea, Rare pancreatitis, cholecystitis||Renal/hepatic insufficiency, pregnancy, psychiatric disorder, past pancreatitis|
|Naltrexone/Bupropion||8/90 mg||4.8% in 1 year||Nausea, headache, dizzy and dry mouth||Antidepressants,|
|Topiramate||12.5 mg mane||25, 50, 100 mg||3.4-5 kg||Insomnia, dry mouth, paraesthesia, altered taste, dizziness, depression||Glaucoma, renal stones, pregnancy||Off label|
|Phentermine/topiramate||15 mg/12.5 mg mane||15/12.5- 100 mg||5-6.6% in 1 year||As above||As above||Off label|
|Metformin||500 mg||500-2000 mg||0.6-1.2 kg||Bloating, diarrhea, Vit B12 deficiency, hypoglycemia||Renal problems||Off label|
|SGLT-2 (dapagliflozin, canagliflozin, empagliflozin)||1.8 – 2.7 kg||Genital and urinary tract infections||Renal problems||Off label|