Table 8.2

Medications approved by the FDA for the treatment of obesity

Medication nameTypical adult maintenance doseAverage wholesale price (30-day supply) (100)National Average Drug Acquisition Cost (30-day supply) (101)1-Year (52- or 56-week) mean weight loss (% loss from baseline)
Treatment armWeight loss (% loss from baseline)Common side effects (102107)Possible safety concerns/considerations (102107)
Short-term treatment (≤12 weeks)
 Phentermine (108)8–37.5 mg q.d.*$5–$56 (37.5 mg dose)$4 (37.5 mg dose)15 mg q.d.6.1Dry mouth, insomnia, dizziness, irritability• Risk of severe hypertension
7.5 mg q.d.5.5• Contraindicated for use in combination with monoamine oxidase inhibitors
PBO1.7
Long-term treatment (>12 weeks)
 Lipase inhibitor
  Orlistat (3)60 mg t.i.d. (OTC)$41–$82$42120 mg t.i.d.9.6Abdominal pain, flatulence, fecal urgency, back pain, headache• Potential malabsorption of fat-soluble vitamins (A, D, E, K) and of certain medications (e.g., cyclosporine, thyroid hormone, anticonvulsants, etc.)
120 mg t.i.d. (Rx)$748$556PBO5.6• Rare cases of severe liver injury reported
• Cholelithiasis
• Nephrolithiasis
 Selective serotonin (5-HT) 5-HT2C receptor agonist
  Lorcaserin (14)10 mg b.i.d.$318$25510 mg b.i.d.4.5Headache, nausea, dizziness, fatigue, nasopharyngitis• Serotonin syndrome– and neuroleptic malignant syndrome–like reactions theoretically possible when coadministered with other serotonergic or antidopaminergic agents
  Lorcaserin XR20 mg q.d.$318$254PBO1.5• Monitor for depression or suicidal thoughts
• Worsening hypertension
• Avoid in liver and renal failure
 Sympathomimetic amine anorectic/antiepileptic combination
  Phentermine/ topiramate ER (109)7.5 mg/46 mg q.d.§$223 (7.5 mg/46 mg dose)$178 (7.5 mg/46 mg dose)15 mg/92 mg q.d.9.8Constipation, paresthesia, insomnia, nasopharyngitis, xerostomia• Birth defects
7.5 mg/46 mg q.d.7.8• Cognitive impairment
PBO1.2• Acute angle-closure glaucoma
 Opioid antagonist/antidepressant combination
  Naltrexone/ bupropion ER (15)8 mg/90 mg, 2 tablets b.i.d.$334$26716 mg/180 mg b.i.d.5.0Constipation, nausea, headache, xerostomia, insomnia• Contraindicated in patients with uncontrolled hypertension and/or seizure disorders
PBO1.8• Contraindicated for use with chronic opioid therapy
• Acute angle-closure glaucoma
  • Black box warning:

  • • Risk of suicidal behavior/ideation

 Glucagon-like peptide 1 receptor agonist
  Liraglutide (16)3 mg q.d.$1,441$1,1543.0 mg q.d.6.0Hypoglycemia, constipation, nausea, headache, indigestion• ?Acute pancreatitis
1.8 mg q.d.4.7
PBO2.0
  • Black box warning:

  • • Risk of thyroid C-cell tumors

  • • Contraindicated with personal or family history of MTC or MEN 2

  • All medications are contraindicated in women who are or may become pregnant. Women of reproductive potential must be counseled regarding the use of reliable methods of contraception. Select safety and side effect information is provided; for a comprehensive discussion of safety considerations, please refer to the prescribing information for each agent. b.i.d., twice daily; ER, extended release; MEN 2, multiple endocrine neoplasia syndrome type 2; MTC, medullary thyroid carcinoma; OTC, over the counter; PBO, placebo; q.d., daily; Rx, prescription; t.i.d, three times daily; XR, extended release.

  • * Use lowest effective dose; maximum appropriate dose is 37.5 mg.

  • Duration of treatment was 28 weeks in a general obese adult population.

  • Enrolled participants had normal (79%) or impaired (21%) glucose tolerance.

  • § Maximum dose, depending on response, is 15 mg/92 mg q.d.

  • Approximately 68% of enrolled participants had type 2 diabetes or impaired glucose tolerance.