Table 8.2

Medications approved by the FDA for the treatment of obesity

1-Year (52- or 56-week) mean weight loss (% loss from baseline)
Medication nameTypical adult maintenance doseAverage wholesale price (30-day supply) (108)National Average Drug Acquisition Cost (30-day supply) (109)Treatment armWeight loss (% loss from baseline)Common side effects (110115)Possible safety concerns/considerations (110115)
Short-term treatment (≤12 weeks)
 Phentermine (116)8–37.5 mg q.d.*$5–$56 (37.5 mg dose)$3 (37.5 mg dose)15 mg q.d.6.1Dry mouth, insomnia, dizziness, irritability, increased BP• Contraindicated for use in combination with monoamine oxidase inhibitors
7.5 mg q.d.5.5
PBO1.2
Long-term treatment (>12 weeks)
Lipase inhibitor
  Orlistat (3)60 mg t.i.d. (OTC)$41–$82$43120 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)$823$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.$360$28810 mg b.i.d.4.5Headache, nausea, dizziness, fatigue, nasopharyngitis, increased BP• Serotonin syndrome–like and neuroleptic malignant syndrome–like reactions theoretically possible when coadministered with other serotonergic or antidopaminergic agents
  Lorcaserin XR20 mg q.d.$360$287PBO1.5• Monitor for depression or suicidal thoughts
• Avoid in liver and renal failure
Sympathomimetic amine anorectic/antiepileptic combination
  Phentermine/topiramate ER (117)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, increased BP• 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$26816 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.$1,497$1,1993.0 mg q.d.6.0Gastrointestinal side effects common (nausea, vomiting, diarrhea), injection site reactions• ?Acute pancreatitis
1.8 mg q.d.4.7• Caution when initiating or increasing dose due to potential risk of acute kidney injury
PBO2.0Black box warning:
• Risk of thyroid C-cell tumors
  • 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; BP, blood pressure; 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.

  • ** Agent has demonstrated cardiovascular safety in a dedicated cardiovascular outcome trial (118,119).

  • 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.