7. Obesity Management for the Treatment of Type 2 Diabetes
Article Figures & Tables
Tables
- Table 7.2
Medications approved by the FDA for the long-term (more than a few weeks) treatment of obesity
1-Year weight change status2–5 Adverse effects2,6–12 Generic drug name (proprietary name[s]) and dosage strength and form Adult dosing frequency Average wholesale price (per month)1 Average weight loss relative to placebo % Patients with ≥5% loss of baseline weight Common7 Serious7 Lipase inhibitor Orlistat (Alli) 60 mg caps or orlistat (Xenical) 120 mg caps 60 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 warfarin Liver failure and oxalate nephropathy Selective serotonin (5-HT) 5-HT2C receptor agonist Lorcaserin (Belviq) 10 mg tabs 10 mg b.i.d. $263 3.2 kg 38–48% Hypoglycemia, headache, fatigue Serotonin 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 caps Recommended 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, headache Topiramate is teratogenic and has been associated with cleft lip/palate Opioid antagonist/aminoketone antidepressant combination Naltrexone/bupropion (Contrave) 8 mg/90 mg tabs Maximum 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, vomiting Depression, precipitation of mania, contraindicated in patients with a seizure disorder Acylated human glucagon-like peptide 1 receptor agonist Liraglutide (Saxenda) 6 mg/mL prefilled pen Maintenance dose: 3 mg s.c. q.d. $1,385 5.8–5.9 kg 51–73% Hypoglycemia, nausea, vomiting, diarrhea, constipation, headache Pancreatitis, 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.
