Drugs for Weight Loss

Question 1

Orlistat

Answer 1

IND: Obesity Management
MOA: OTC. Works in GI tract, inhibits gastric and pancreatic enzymes; inhibits break down of fats, decreasing absorption
BOX: N/A
CON: Pregnancy, malabsorption syndromes, cholestasis
ADR: All within GI tract. Oily stool, fecal urgency, diarrhea, cramping. Dosing with Metamucil can greatly reduced the ADRs by binding the fat.
SIGNIFICANT drug interactions: Separate from levothyroxine by at least 4 hours. Reduces absorption of fat soluble vitamins A, D E K, separate by 2 hours
Warfarin: Vit K deficiency intensifies warfarin effects

Question 2

Liraglutide

Answer 2

IND: Chronic weight management, T2DM
MOA: Glucagon-like peptide 1 (GLP1) Agonist. Increases insulin secretion, decreases glucagon secretion. Slows gastric emptying (tells body I’m full)+
BOX: Thyroid C Cell tumors in rats and mice
CON: Pregnancy, MEN2, Medullary Thyroid Carcinoma
ADR: Increased HR (10-20BPM). Hypoglycemia with combination therapy with other diabetic agents. GI

Question 3

Semaglutide

Answer 3

IND: Weight loss, T2DM
MOA: GLP1 Agonist
BOX: Thyroid C cell tumors in rats and mice
CON: Pregnancy, Medullary thyroid carcinoma, MEN2
ADR: Hypoglycemia and GI

Question 4

Phentermine

Answer 4

IND: Obesity, short term
MOA: Sympathomimetic; reduction in appetite d/t increased NE. Like amphetamines. Controlled
BOX: N/A
CON: CVD, hyperthyroidism, glaucoma, drug abuse, MAOIs, pregnancy, breast feeding
ADR: CV; tachy, HTN, palpitations, ischemia. CNS; euphoria, insomnia, restlessness, psychosis
Avoid in renal impairment

Question 5

Phentermine/Topiramate

Answer 5

IND: Weight Management
MOA: Phentermine + many potential mechanisms that lead to appetite suppression
BOX: REMS: congenital malformation; avoid in pregnancy and immediately d/c if pregnant.
CON: CVD and CNS (same as Phentermine)
ADR: Same as Phentermine. Decreases serum bicarb; acidosis
Renal and hepatic impairments

Question 6

Naltrexone/Buproprion

Answer 6

IND: Chronic Weight Management
MOA: Not fully understood. Appetite regulatory center, DA and the mesolimbic reward system.
BOX: Antidepressants
CON: Chronic opiate use, seizures, Uncontrolled HTN, abrupt d/c of ethanol/sedatives, conditions that lower seizure threshold, bulimia or anorexia
ADR: Insomnia, GI disturbances, Tachy
Renal and hepatic impairment

Question 7

Setmelanotide

Answer 7

IND: Weight Management in pts with proopiomelanocortin, proprotein convertase subtilisin/kexin type 1, or leptin deficiency
MOA: Melanocortin 4 receptor agonist; regulates hunger. Decreased calories/increase expenditure.
BOX: N/A
CON: None
ADR:

Question 8

Lorcaserin

Answer 8

Increased occurrence of cancer and is now discontinued

Question 9

Lifelong management

Answer 9

Behavioral modification and appetite regulation provides a ton of benefits

Question 10

Treatment goals and options

Answer 10

10-15% weight loss and a target of 10% weight loss over the first 6 months
After that, drugs lose their effect and lifestyle modification is indicated.
High likelihood of regaining the weight
All CONTRAINDICATED in pregnancy.