Weight Loss Drugs

Class Name MOA Indicatio Adverse Notes

n
CNS Phentermi Give w/ Most efficacious
ne Increase release of monoamines from Topiramat Tachycardia Contraindications:
VMAT on neurons -> NE and Dopamine e
release Hypertension Amphetamines

Potent CNS stimulant MAOI's

Anxiety
Anorexic properties,
CNS and cardiovascular events IHD

CAD

Topiramat Give w/
e Anticonvulsant Phentermi Teratogen
ne
Reduced appetite Dizziness, parenthesis, CNS effect
Reduces taste of (start slow)
certain foods
High dose -> metabolic acidosis

Bupropion Give w/
Blocks DAT reuptake Naltrexon Nausea Smoking cessation
e pill
Increases synaptic DA Anxiety
Slight increase in synaptic NE Antidepressant
Antidepressant properties Worsen HTN
DA stimulates POMC center ->
reduce appetite and food
Lowers seizures threshold
seeking behaviors
Alters DA reward system ->
reduces food craving
Naltrexon Give w/ Reduce cravings in
e Antagonizes central Mu opioid receptors Bupropion Liver dysfunction (in alcoholics) alcoholics or
to prevent endogenous opioids from opioid addicts
inhibiting pro opiomelanocortin cells GI: diarrhea, cramps
(POMC)
Opioid withdrawal in pts on opioids
Activated POMC produce peptides
that result in anorexic effects
 Net: decreased appetite and food
seeking behavior
Lorcaserin Least efficacious
Agonist at 5HT2c (serotonin) receptors Serotonin syndrome if taken w/
SSRI
Stimulate POMC -> reduce appetite
and feeding Neuroleptic malignant syndrome

Interfere with atypical

antipsychotics - may worsen
psychosis in susceptible patients

GI: diarrhea, constipation

GLP-1 Weight Good for type II
agonist Liraglutid Injectable GLP-1 receptor agonist loss w/ or Nausea, GI upset DM because it
e w/o DM promotes weight
Increases insulin sensitivity type II Pancreatitis loss
(injectable Decreases appetite and slows
) gastric emptying Delayed gastric emptying -
Decreases prandial glucagon interfere w/ other oral
secretion medication absorption

Possible increase risk of thyroid or

pancreatic tumors/cancers

Increased risk of hypoglycemia if

used with other hypoglycemic
agents (no risk in non-diabetics)
Orlistat Inhibits gastrointestinal lipase to decrease OTC or
Pancrea fat absorption Decrease absorption of fat soluble prescription
tic vitamins and drugs

Lipase Gallbladder disease

inhibitor
Steatorrhea
Always try diet and exercise first
Weight loss drugs FDA approved for pts in the following two categories:
o BMI> 30kg/m^2 and failure to respond to lifestyle interventions
o BMI>27kg/m^2 with weight induced comorbidities (DM, Heart disease)
If weight gain is being cause by some disease or drug (atypical antipsychotics), treat the disease or consider changing the
drug