|
Availability |
Mechanism of action |
Dose |
Common adverse events and contraindications |
Efficacy in kg/% of body weight loss (1 year, placebo subtracted, ITT population) |
|
Orlistat | ||||
|
US (FDA has approved orlistat for children aged ≥12 years), Canada, Europe |
GI lipase inhibitor (decreases fat absorption) |
120 mg PO tid with meals |
GI: oily spotting, gas with discharge, fecal urgency, fatty or oily stools, increased defecation, fecal incontinence |
~3% |
|
Phentermine/topiramate | ||||
|
US |
Amphetamine analogue/anticonvulsant |
3.75/23 mg to 15/92 mg PO daily |
Xerostomia, paresthesia, insomnia, constipation, dysgeusia, and dizziness; contraindicated in patients with glaucoma, hyperthyroidism, concomitant use of MAOIs; known hypersensitivity or idiosyncrasy to the sympathomimetic amines |
6.7 kg/6.6% (dose, 7.5/46 mg) 8.8 kg/8.6% (dose, 15/92 mg) |
|
Liraglutide (3.0 mg/d) | ||||
|
US, Canada, Europe |
GLP-1 receptor agonist (increases satiety, delays gastric emptying, decreases food reward) |
0.6 mg/d SC, increase by 0.6 mg/wk until target dose of 3.0 mg/d SC is reached |
Nausea, diarrhea, constipation, vomiting and headache; contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, MEN 3, or pancreatitis |
4%-5.4% |
|
Semaglutide (2.4 mg/wk) SC | ||||
|
US, Canada/Europe (approved but not available) |
GLP-1 receptor agonist (increases satiety, delays gastric emptying, decreases food reward) |
Weekly SC injections: 0.25 mg for 4 weeks, 0.5 mg for 4 weeks, 1.0 mg for 4 weeks, 1.7 mg for 4 weeks; target dose: 2.4 mg SC/wk |
Nausea, diarrhea, constipation, vomiting and headache; contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, MEN 3, or pancreatitis |
12.5% |
|
Tirzepatide | ||||
|
US, Canada, Europe (as of February 2023, approved only for type 2 diabetes) |
Dual GIP/GLP-1 receptor agonist (increases satiety, delays gastric emptying, decreases food reward) |
Weekly SC injection, 3 therapeutic doses: 5 mg, 10 mg, 15 mg Start at 2.5 mg/wk and increase by 2.5 mg every 4 weeks until therapeutic dose is reached |
Nausea, diarrhea, constipation, vomiting and headache; contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, MEN 3, or pancreatitis |
11.9% (5 mg dose), 16.4% (10 mg dose), 17.8% (15 mg dose) |
|
Naltrexone HCl/bupropion HCl | ||||
|
US, Canada, Europe |
Opioid receptor antagonist/dopamine and norepinephrine reuptake inhibitor (decreases cravings from the mesolimbic reward system and hunger) |
8/90 mg/d (1 tablet) PO, increase by 1 tablet/wk until target dose of 2 tablets PO bid is reached |
Nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth, and diarrhea; contraindicated in uncontrolled hypertension, seizure disorders, patients using other bupropion-containing products, in bulimia or anorexia nervosa (increases the risk of seizures), chronic opioid use, abrupt discontinuation of alcohol intake, with benzodiazepines, barbiturates, antiepileptic drugs, and MAOIs |
3.3%-4.8% |
|
bid, 2 times a day; FDA, Food and Drug Administration; GI, gastrointestinal; GIP, glucose-dependent insulinotropic peptide; GLP-1, glucagon-like peptide 1; ITT, intention to treat; MAOIs, monoamine oxidase inhibitors; MEN 2, multiple endocrine neoplasia type 2; MEN 3, multiple endocrine neoplasia type 3; MTC, medullary thyroid cancer; PO, oral; SC, subcutaneous; tid, 3 times a day. | ||||