Weight LOSS medications don't always work

Saxenda and orlistat, both are available in Egyptian community pharmacies. Save weight loss medications for patients with a BMI ≥ 30 or ≥ 27....

New guidelines will encourage using weight loss drugs to control obesity and weight-related conditions in some patients. We know that lifestyle changes are still first-line and adding medications may help patients adhere to their diet. But weight loss medications don't always work and there's no proof yet that they improve long-term outcomes.

Expect about one in 2 patients to have at least a 5% weight loss on Qsymia (NOT available in Egypt) after one year, and just one in 4 or 5 patients with Saxenda, Contrave, Belviq, or orlistat. Saxenda and orlistat, both are available in Egyptian community pharmacies. Save weight loss medications for patients with a BMI ≥ 30 or ≥ 27 with a weight-related condition (diabetes, hypertension, etc). In general, stop the medication if a patient doesn't lose ≥ 5% of body weight after 12 weeks on maximum doses. Use this table to help compare options...

Table (1). Medications for Weight Loss
Drug ~ Weight Loss VS Placebo at 1 year Stopped Due to Side Effects Possible Drawbacks and Considerations
Qsymia
(phentermine/ topiramate ER)
9 kg (19 lbs)
1 in 12 at highest dose
Impaired cognition, metallic taste, paresthesia

Monitor heart rate
Saxenda (liraglutide) 5.4 kg (12 lbs) 1 in 18 Nausea, rare hypoglycemia
Contrave
(naltrexone/ bupropion ER)
4 kg (9 lbs) 1 in 9 Nausea, seizures

Avoid with opioids, seizure disorders, and uncontrolled hypertension
Belviq (lorcaserin) 3.5 kg (8 lbs) 1 in 53 Dizziness, fatigue

Be careful with other serotonergic drugs
Orlistat (Xenical) 3 kg (7 lbs) 1 in 26 Nausea, diarrhea, fecal urgency

Avoid in cholestasis, chronic malabsorption
Phentermine 2 kg (5 lbs) 1 in 9 Agitation, insomnia

Avoid in heart disease, uncontrolled BP
NOTE: Saxenda and orlistat are available in Egypt, other are not available.

NPS-adv

Also watch for medications that can lead to significant weight GAIN, such as; olanzapine (Olapex), gabapentin (Conventin), paroxetine, sulfonylureas (Amaryl), etc. Use our NOTE, "Consider alternatives to medications that can lead to significant weight gain", for alternatives. And get our GUIDANCE, "7 Diet, a professional guide for weight loss", INCLUDE 7 STEPS WHICH ARE designed for clinical nutritionists to help overweight and obese patients, it also contains a full chart of weight loss medications. Read our note, "New products to try to lose weight", to get more data about weight LOSS medications which are available in Egypt.


References

  1. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Feb;100(2):342-62.
  2. Yanovski SZ, et al. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86.
  3. Jensen MD, Ryan DH, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2985-3023.