Table 7.2

Medications approved by the FDA for the long-term (more than a few weeks) treatment of obesity

1-Year weight change status25Adverse effects2,612
Generic drug name (proprietary name[s]) and dosage strength and formAdult dosing frequencyAverage wholesale price (per month)1Average weight loss relative to placebo% Patients with ≥5% loss of baseline weightCommon7Serious7
Lipase inhibitor
Orlistat (Alli) 60 mg caps or orlistat (Xenical) 120 mg caps60 mg or 120 mg t.i.d. (during or up to 1 h after a low-fat meal)$43–86 (60 mg);
$670 (120 mg)
2.5 kg (60 mg);
3.4 kg (120 mg)
35–73%Abdominal pain/discomfort, oily spotting/stool, fecal urgency, flatulence, malabsorption of fat-soluble vitamins (A, D, E, K) and medications (e.g., cyclosporine, thyroid hormone replacement, or anticonvulsants), potentiation of the effects of warfarinLiver failure and oxalate nephropathy
Selective serotonin (5-HT) 5-HT2C receptor agonist
Lorcaserin (Belviq) 10 mg tabs10 mg b.i.d.$2633.2 kg38–48%Hypoglycemia, headache, fatigueSerotonin syndrome or NMS-like reactions, suicidal ideation, heart valve disorder (<2.4%), bradycardia
Sympathomimetic amine anorectic/antiepileptic combination
Phentermine/topiramate ER (Qsymia) 3.75 mg/23 mg caps, 7.5 mg/46 mg caps, 11.25 mg/69 mg caps, 15 mg/92 mg capsRecommended dose: 3.75 mg/23 mg q.d. for 14 days, then increase to 7.5 mg/46 mg q.d. Maximum dose: 15 mg/92 mg q.d.$239 (maximum dose using the highest strength)6.7 kg (7.5 mg/46 mg);8.9 kg (15 mg/92 mg)45–70%Paresthesia, xerostomia, constipation, headacheTopiramate is teratogenic and has been associated with cleft lip/palate
Opioid antagonist/aminoketone antidepressant combination
Naltrexone/bupropion (Contrave) 8 mg/90 mg tabsMaximum dose: two tablets of Contrave b.i.d. for a total daily dosage of naltrexone 32 mg/bupropion 360 mg$251 (maximum dose)2.0–4.1 kg (32 mg/360 mg)36–57%Nausea, constipation, headache, vomitingDepression, precipitation of mania, contraindicated in patients with a seizure disorder
Acylated human glucagon-like peptide 1 receptor agonist
Liraglutide (Saxenda) 6 mg/mL prefilled penMaintenance dose: 3 mg s.c. q.d.$1,3855.8–5.9 kg51–73%Hypoglycemia, nausea, vomiting, diarrhea, constipation, headachePancreatitis, thyroid C-cell tumors in rodents, contraindicated in patients with personal/family history of MTC or MEN2, acute renal failure
  • All medications are contraindicated in women who are or may become pregnant. Women in their reproductive years must be cautioned to use a reliable method of contraception. Caps, capsules; ER, extended release; MEN2, multiple endocrine neoplasia type 2; MTC, medullary thyroid carcinoma; NMS, neuroleptic malignant syndrome; s.c., subcutaneous; tabs, tablets.

  • 1 RED BOOK Online. Micromedex 2.0 (electronic version). Truven Health Analytics, Greenwood Village, CO.

  • 2 Physicians' Desk Reference. PDR Network, LLC (electronic version). Truven Health Analytics, Greenwood Village, CO.

  • 3 Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA 2014;311:74–86.

  • 4 Astrup A, Carraro R, Finer N, et al.; NN8022–1807 Investigators. Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. Int J Obes (Lond) 2012;36:843–854.

  • 5 Wadden TA, Hollander P, Klein S, et al.; NN8022–1923 Investigators. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond) 2013;37:1443–1451.

  • 6 DrugPoints System (electronic version). Truven Health Analytics, Greenwood Village, CO.

  • 7 Selective common (defined as an incidence of >5%) and serious adverse effects are noted. Refer to the medication package inserts for full information about adverse effects, cautions, and contraindications.

  • 8 Data of common adverse effects for Xenical were derived from seven double-blind, placebo-controlled clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes), but the percentage of patients with type 2 diabetes was not reported. In clinical trials in obese patients with diabetes, hypoglycemia and abdominal distension were also observed.

  • 9 Data of common adverse effects for Belviq were derived from placebo-controlled clinical trials in patients with type 2 diabetes.

  • 10 Data of common adverse effects for Qsymia were derived from four clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes); 13% had type 2 diabetes.

  • 11 Data of common adverse effects for Contrave were derived from five double-blind, placebo-controlled clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes); 13% had type 2 diabetes.

  • 12 Data of common adverse effects for Saxenda were derived from clinical trials in mixed-type study populations (i.e., patients with or without type 2 diabetes). Percentage of patients with type 2 diabetes was not reported.