Weight Loss Drugs Flashcards
when is pharmacologic therapy for weight loss approved
- BMI ≥30
- BMI ≥27 with one or more comorbidities (T2DM, HLD, HTN, sleep apnea)
FDA approved medications for weight loss are indicated to be used as ______
adjunct to behavior modifications (diet and exercise)
short term (12 weeks) medications for weight loss
phentermine (not recommended)
long term (>12 weeks) medications for weight loss
orlistat, phentermine/topiramate ER, naltrexone ER/bupropion ER, liraglutide and semaglutide
phentermine class
sympathomimetic amine
phentermine MOA
suppresses appetite and increases metabolic rate so you feel less hungry and burn more calories. raises noradrenaline levels with increasing sympathetic nervous system (fight or flight)
phentermine dosing
37.5 mg daily
phentermine schedule
CIV
phentermine adverse
Increased HR and BP, dry mouth, constipation
phentermine contraindications
known CV disease (uncontrolled HTN), hyperthyroidism, history of drug abuse, use of MAOI inhibitors in the last 14 days, agitation, pregnancy X, nursing
orlistat class
gastrointestinal lipase inhibitor
orlistat MOA
reversible inhibitor of gastrointestinal lipases in the stomach and small intestine preventing digestion of triglycerides
orlistat brands
xenical (rx) and alli (otc)
orlistat dosing
xenical: 120 mg PO TID with meals
alli: 60 mg PO TID with meals
timing with orlistat to meals
can be taken as early as 1 hour before or as late as 1 hour after meals
orlistat ADE
diarrhea, oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, increased defecation and fecal incontinence
orlistat ADEs are related to ___
diet; more likely to occur with meal >15 gm fat
orlistat contraindications
chronic malabsorption syndrome, cholestasis, pregnancy X
orlistat counseling
due to decreased fat soluble vitamin absorption, take a multivitamin AT BEDTIME to make sure you get enough of vitamins ADEK that your body might not absorb from the foods you eat
orlistat drug interactions
cyclosporine, levothyroxine, warfarin, AED
when to assess orlistat
at 12 weeks, discontinue if weight loss not at least 5%
phentermine/topiramate ER class
sympathomimetic/anti-seizure
phentermine/topiramate ER mechanism
phentermine MOA + anti seizure possibly increases POMC activity
phentermine/topiramate ER schedule
CIV
initial dose titration for phentermine/topiramate
Days 1-14: 3.75 mg/23 mg QAM
Then 7.5 mg/46 mg QAM
when to assess for phentermine/topiramate ER
at 12 weeks if weight loss ≥3% continue recommended dose.
If weight loss is <3% titrate to:
Days 1-14: 11.25 mg/69 mg QAM
Then 15 mg/92 mg QAM (top dose)
phentermine/topiramate ER ADEs
increased HR and BP, dry mouth, constipation, tingling of hands and feet, dizziness, altered taste, insomnia
phentermine/topiramate ER monitring
renal dose adjust for CrCL <50 mL/min
hepatic dose adjust for Child Pugh Class B
Mood disorders (suicidal ideation)
phentermine/topiramate ER contraindications
known CV disease (uncontrolled HTN), hyperthyroidism, use of MAOI inhibitors in the last 14 days, glaucoma, pregnancy, nursing
phentermine/topiramate ER REMS
pregnancy category X: topiramate is a known teratogen. hormonal contraceptives need additional form of birth control
naltrexone ER/bupropion ER class
combination opioid antagonist/aminoketone antidepressant
naltrexone ER/bupropion ER mechanism
aminoketone bupropion ER: dopamine and norepinephrine reuptake inhibitor–> increases POMC activity–> sensation of satiety
opioid antagonist naltrexone ER: opioid receptor antagonist–> after increased POMC activity, the beta-endorphins feedback to inhibit POMC–> naltrexone blocks beta-endorphin activity, enhancing the action of bupropion
naltrexone ER/bupropion ER dosing
Week 1: 1 tablet AM
Week 2: 1 tablet AM and 1 tablet PM
Week 3: 2 tablets Am and 1 tablet PM
Week 4 onward: 2 tablets AM and 2 tablets PM
counseling for naltrexone ER/bupropion ER
do not take with a high fat meal (increased exposure)
when to assess naltrexone ER/bupropion ER
assess at 12 weeks and discontinue if weight loss not at least 5%
naltrexone ER/bupropion ER ADEs
nausea, constipation, HA, vomiting
naltrexone ER/bupropion ER precautions
renal dose adjust CrCL <50 mL/min
hepatic dose adjust
dose adjust with CYP2B6 inhibitors (clopidogrel)
can cause increased HR and BP
cases of hepatitis reported with naltrexone
naltrexone ER/bupropion ER contraindications
uncontrolled HTN, chronic opioid use, recent discontinuation of alcohol, BZD, barbiturates, AED’s, MAOI inhibitors in the last 14 days, pregnancy X
naltrexone ER/bupropion ER BBW
increased risk of suicidal ideation with antidepressants for ages 18-24: have family assist with monitoring
GLP-1 agonists FDA approved for weight loss and T2DM
liraglutide and semaglutide
how do GLP-1 agonists work for weight loss
endogenous GLP-1 is released by L cells in ileum and colon in response to food digestion
-stimulates pancreas to increase insulin and decrease glucagon
-stimulates the brain to reduce appetite
-stimulates GI tract to slow gastric emptying
what is the brand name of liraglutide for weight loss
saxenda
saxenda (liraglutide) dosing
week 1: 0.6 mg daily
week 2: 1.2 mg daily
week 3: 1.8 mg daily
week 4: 2.4 mg daily
week 5 onward: 3 mg daily
if patient cannot tolerate GI events, a dose increase may be delayed by a week. if the adult patient cannot tolerate the 3 mg dose at all, discontinue. if the pediatric patient cannot tolerate the 3 mg dose, they can have 2.4 mg dose. if the pediatric patient cannot tolerate the 2.4 mg dose, discontinue.
what is the brand name of semaglutide for weight loss
wegovy
wegovy dosing
WEEKLY (not daily)
week 1-4: 0.25 mg weekly
week 5-8: 0.5 mg weekly
week 9-12: 1 mg weekly
week 13-16: 1.7 mg weekly
week 17 onward: 2.4 mg weekly
if the patients do not tolerate 2.4 mg dose, temporarily decrease to 1.7 mg for a maximum of 4 weeks, then try 2.4 mg again and discontinue if they cannot tolerate it.
GLP-1 ADEs
n/v/d, constipation, decreased appetite, dizziness, abdominal pain, dyspepsia, fatigue, increased lipase
GLP-1 precautions
may increase chance of hepatitis, increase HR by 10-20 BPM, hypoglycemia if taking insulin or a sulfonylurea
GLP-1 contraindications
history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2, pregnancy X
GLP-1 BBW
thyroid C cell tumors, including MTC
GLP-1 counseling
saxenda: refrigerator, room temp once opened, for 30 days
wegovy: refrigerator, each pen is single use
when to evaluate for saxenda
at week 16. if weight loss <4%, discontinue
