Weight Loss Drugs Flashcards
Overweight
BMI: 25-29.9 kg/m2
Obese
BMI ≥ 30 kg/m2
Select drugs that can cause weight gain:
- Antipsychotics (eg, clozapine, olanzapine, risperidone, quetiapine)
- Diabetes drugs (insulin, meglitinides, sulfonylureas, thiazolidinediones)
- Divalproex/valproic acid
- Gabapentin, pregabalin
- Lithium
- Mirtazapine
- Steroids
- TCAs (e.g., amitriptyline, nortriptyline)
- Conditions: hypothyroidism
Others: beta-blockers, dronabinol, hormones (eg, estrogen, megestrol), MAO inhibitors, SSRIs (paroxetine), vasodilators (e.g., minoxidil)
Select drugs that can cause weight loss:
- ADHD drugs (e.g., amphetamine, methylphenidate)
- Bupropion
- GLP-1 agonists (e.g. exenatide, liraglutide)
- Pramlintide
- Roflumilast
- SGLT2 inhibitors (e.g. canagliflozin, empagliflozin)
- Topiramate
- Conditions: hyperthyroidism, celiac disease, inflammatory bowel disease
Others: acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine); antiepileptic drugs (zonisamide, ethosuximide), interferons, thyroid drugs (e.g., levothyroxine)
Conditions: cystic fibrosis, GERD or peptic ulcer disease, lupus, TB
Prescription drugs for weight loss can be recommended if the patient:
- has a BMI ≥ 27 + presence of at least one comorbid condition (HTN, T2D, dyslipidemia)
- is obese (BMI 30-39.9)
Physical activity should be increased to ≥ 150 minutes/week; performed on:
3-5 separate days
Weight loss drugs should be discontinued if they do not produce at least a…
5% weight loss at 12 weeks
Older stimulant drugs (e.g. phentermine, diethylpropion) are only used…
short-term to “jump-start” a diet
The newer drugs can be continued long-term for weight maintenance:
Qsymia, Contrave, Saxenda, orlistat formulations
Phentermine/Topiramate ER (Qsymia)
C-IV. REMS drugs due to tetratogenic risk; pregnancy test needed before tx and monthly thereafter; use effective contraception during tx;
Notes: taper off due to seizure risk
Start: 3.75 mg/23 mg PO QAM x 14 days; titrate up based on weight loss
Max dose: 15 mg/92 mg PO QAM
CrCl< 50 mL/min; max dose is 7.5 mg/46 mg/day
C/I: Pregnancy, glaucoma, hyperthyroidism, MAO inhibitor use within past 14 days
S/Es: Tachycardia, CNS effects (eg, insomnia), depression, anxiety, suicidal thoughts, headache, paresthesia, vision problems, constipation, dry mouth, increase SCr, upper respiratory tract infection
Naltrexone/Bupropion (Contrave)
Notes: Do not cut, chew, or crush; swallow whole. Do not take with high-fat meal. Discontinue opioids or buprenorphine 7-14 days before using Contrave
ER tablet: 8 mg/90 mg Week 1: 1 tab PO QAM Week 2: 1 tab PO QAM, 1 tab PO QPM Week 3: 2 tabs PO QAM, 1 tab PO QPM Week 4: 2 tabs PO QAM, 2 tabs PO QPM
C/Is: Pregnancy, chronic opioid use or acute opiate withdrawal, uncontrolled HTN, seizure disorder, use of other bupropion-containing products, bulimia/anorexia, abrupt discontinuation of alcohol, benzos, barbiturates, antiepileptic drugs, use of MAO inhibitors within 14 days. Warnings: Use caution with psychiatric disorders, d/c with s/sx of liver toxicity, can increase HR and BP, glaucoma
Liraglutide (Saxenda)
Approved for use in children age ≥ 12 years with weight > 60 kg and BMI corresponding to ≥ 30 kg/m2 for adults
Start 0.6 mg SC daily x 1 week; titrate up by 0.6 mg SC daily at weekly intervals. Target dose: 3 mg SC daily. Titrate to reduce GI effects.
Boxed Warning: risk of thyroid C-cell carcinoma. C/Is: Pregnancy, personal or family history of medullary thyroid carcinoma (MTC) or patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
Warnings: Pancreatitis, hypoglycemia, acute gallbladder disease, gastroparesis (slows gastric emptying). S/e: nausea, vomiting, diarrhea, constipation, injection site rxns
Lipase inhibitor (decrease absorption of dietary fats by ~30%). Must stick to dietary plan for both weight improvement and to help lessen GI side effects (max 30% of kcals from fat)
orlistat; Rx- Xenical; OTC- Alli
Indicated in ages > 12 years
Notes: must be used with a low-fat diet plan. Take multivitamin with A, D, E, K, and beta carotene at bedime or separated by ≥ 3 hours; separate levothyroxine by ≥ 4 hours
Xenical: 120 mg PO w/ each meal containing fat; take with meal or up to 1 hr after eating
Alli: 60 mg PO w/ each meal containing fat
C/Is: Pregnancy, chronic malabsorption syndrome, cholestasis
Warnings: Liver damage (rare), cholelithiasis, increased urinary oxalate/kidney stones, hypoglycemia (in patients with diabetes)
Side effects: GI (flatus with discharge, fatty stool, fecal urgency)
Phentermine (Adipex-P, Lomaira)
C-IV
15-37.5 mg PO daily, before or after breakfast, or in divided doses
Appetite suppressants
Notes: stimulants taken later in the day can cause insomnia
Potential for misuse/dependence
C/Is: Cardiovascular disease (eg, uncontrolled hypertension, arrhythmias, heart failure, CAD), hyperthyroidism, glaucoma, pregnancy, breast feeding, history of drug abuse, MAO inhibitors within the past 14 days
S/Es: tachycardia, agitation, increased BP, insomnia, dizziness, tremor, psychosis
Monitoring: HR, BP