Test 3 Pharmacotherapy in Weight Loss Flashcards
Qualifiers for pharmacotherapy to treat obesity
- BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with ≥ 1 obesityassociated comorbidity
- Failed to achieve weight loss goal after ≥ 6 months of comprehensive lifestyle intervention
- No contraindications to therapy
- Currently enrolled in ongoing comprehensive lifestyle intervention as previously defined (adjunctive therapy)
What are the two categories of pharmcotherapies?
- long term
- short term
long term pharmcotherapies
- orlistat
- lorcaserin
- phentermine / topiramate ER
- bupropion / naltrexone
short term pharmcotherapies
- phentermine
orlistat initial dose
60 mg TID 1 hour prior to fat-containing meals
orlistat maximum dose
60 mg TID 1 hour prior to fatcontaining meals
orlistat special comments
- Omit if meal skipped or does not contain fat
- Consider multivitamin during therapy to prevent vitamin deficiency
orlistat monitoring
- BMI
- serum glucose in diabetic patients
- thyroid function in patients with hypo- or hyperthyroidism
- liver function tests if symptoms of hepatic dysfunction
orlistat adverse reactions
- Soft stools
- diarrhea
- abdominal pain/bloating
- flatulence
- fecal urgency
- incontinence
- hepatic injury (rare)
lorcaserin initial dose
10 mg BID
lorcaserin maximum dose
10 mg BID
lorcaserin special comments
- Use w/ caution if CrCl 30-50 ml/min.
- Use is not recommended if CrCl<30 ml/min.
- Do not use if severe hepatic dysfunction
lorcaserin monitoring
- BMI – discontinue if <5% weight loss achieved at 12 weeks
- Serum glucose in diabetic patients
- complete blood count
- depression and/or suicidal ideation
- signs/symptoms of serotonin syndrome
- signs/symptoms of valvular heart disease
lorcaserin adverse reactions
- Headache
- dizziness
- fatigue
- nausea
- dry mouth
- constipation
- hypoglycemia in patients with diabetes
- psychiatric disorders
- priapism
- elevated serum prolactin
phentermine / topiramate ER initial dose
3.75 mg phentermine and 23 mg topiramate once
daily in the morning -titrate to 7.5/46 mg after 14 days
phentermine / topiramate ER maximum dose
15 mg phentermine and 92 mg topiramate
phentermine / topiramate ER special comments
- Do not exceed 7.5/46 mg if CrCl<50 ml/min. or moderate hepatic impairment
- Gradually discontinue if on 15/92 mg dose to prevent precipitation of seizure
- Do not use within 14 days of MAOi use
phentermine / topiramate ER monitoring
- BMI
- serum glucose in diabetic patients
- pregnancy
- depression or suicidal ideation
- mood/sleep disorders
- HR
- serum electrolytes and creatinine at baseline and during treatment
phentermine / topiramate ER adverse reactions
- Constipation
- dry mouth
- paraesthesia
- dysgeusia
- insomnia
- hypoglycemia in individuals with diabetes
when to discontinue phentermine / topiramate ER
- Discontinue or escalate dose if 3% weight loss not achieved by week 12 on 7.5/46 mg dose
- Discontinue if 5% weight loss not achieve by week 12 on 15/92 mg dose
bupropion / naltrexone initial dose
1 tablet once daily x1 week, then 1 tablet BID x1 week, then 2 tablets qAM and 1 tablet qPM x1 week, then 2 tablets BID
bupropion / naltrexone maximum dose
2 tabs BID
32 mg naltrexone and 360 mg bupropion per day
bupropion / naltrexone special comments
- Moderate-severe renal impairment: max 1 tablet twice daily
- Hepatic impairment: max 1 tablet daily
- Do not use within 14 days of MAOi use
bupropion / naltrexone monitoring; BOXED warnings
- NOT approved for depression or psychiatric disorders
- ↑↑suicidality and antidepressant drugs
- ↑↑ serious psychiatric effects seen in patients taking bupropion for smoking cessation
- contraindicated in uncontrolled HTN
- seizure disorder of history of seizures
- pregnancy
bupropion / naltrexone adverse reactions
- ↑↑blood pressure
- ↑↑HR
- lowers seizure threshold
- anxiety
- suicidal thoughts/actions
phentermine initial dose
- Adipex: 15 mg once daily (or in 2 divided doses) before meals or 1-2 hours after meals
- Suprenza: 15 mg once daily
- Lomaira: 8 mg TID
phentermine maximum dose
- Adipex: 37.5 mg/day
- Suprenza: 37.5 mg/day
- Lomaira: 8 mg TID, 30 min before meals
phentermine special comments
- Use with caution in severe renal impairment
- Do not use within 14 days of MAOi use
- Avoid abrupt discontinuation
- Discontinue if satisfactory weight loss has not occurred within 4 weeks
phentermine monitoring
- Baseline cardiac evaluation
- cardiac echocardiogram during therapy
- blood pressure
phentermine adverse reactions
- ↑↑blood pressure
- ischemic events (stroke/MI)
- palpitations
- tachycardia
- valvular disease
- urticarial
- agitation
- headache
- dizziness
- insomnia
- psychosis
- dry mouth
- thirst,
- diarrhea
