Several medications are available to help achieve weight loss.
Orlistat is a medication that reduces the absorption of fats from food that is ingested. It should be taken with each meal. Orlistat is the only medication for weight loss available over the counter (in a lower dose than the prescription medication), but you should ask your doctor before taking it. Major side effects of orlistat include gassiness, cramps, and oily stools.
Lorcaserin is a medication that acts on serotonin receptors in the brain to decrease appetite. Headaches and upper respiratory tract infections are possible side effects of lorcaserin. You should not take lorcaserin if you also take other medications that affect serotonin, which include some antidepressants and treatments for migraine headaches.
A combination of phentermine (a stimulant medication) and extended-release topiramate (an antiseizure and antimigraine medication) was approved by the US Food and Drug Administration (FDA) in 2012. Because of the stimulant component, you should not use this medication if you have uncontrolled high blood pressure or heart disease. It can also cause anxiety and insomnia. It may increase the risk of certain birth defects, so women who might become pregnant should use a reliable form of birth control and monitor for pregnancy regularly while taking the drug.
A combination of bupropion (an antidepressant and smoking cessation medication) and naltrexone (a medication for alcohol and opioid dependence) was approved by the FDA in September 2014. The most common side effect is nausea, and this medication can increase heart rate and blood pressure. It should not be used in patients with uncontrolled high blood pressure, those with a history of seizure disorders or anorexia or bulimia, or those undergoing alcohol or drug withdrawal.
Liraglutide is a medication that was previously approved for treatment of type 2 diabetes and has been recently approved in a higher dose as an obesity medication for patients with or without diabetes. It works like a hormone called glucagon-like peptide 1, which helps control blood sugar and also promotes weight loss and maintenance. A higher dose is used to treat obesity than to treat diabetes alone. It is available only as a once-daily injection. The most common side effects are nausea and diarrhea. Blood pressure is usually improved, but there is a small increase in heart rate. There may be an increased risk of pancreatitis. Studies in animals have shown an increased risk of a rare form of thyroid cancer, but it is not known if this is true for humans.
Some other medications are approved for short-term use (<3 months), but they are frequently prescribed by doctors for longer periods. These include phentermine alone (not in combination with topiramate) or other stimulant medications. These can cause increases in heart rate and blood pressure, which should be carefully monitored by a doctor, and can cause other side effects such as dry mouth, difficulty sleeping, and headache.
A recommendation from the Endocrinology Society suggests that doctors prescribe orlistat or lorcaserin instead of stimulant drugs such as phentermine, topiramate, bupropion, and naltrexone for patients who have a history of cardiovascular disease.
Centers for Disease Control and Preventionwww.cdc.gov/healthyweight/losing_weight/index.html
National Institute of Diabetes and Digestive and Kidney Diseaseswww.niddk.nih.gov/health-information/health-communication-programs/win/Pages/default.aspx
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Many are available in English and Spanish. A Patient Page was published in the June 2, 2015, issue describing recommendations for who should take medications for weight loss and how they should be used.
Sources: Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74-86.
Yanovski SZ, Yanovski JA. Naltrexone extended-release plus bupropion extended-release for treatment of obesity. JAMA. 2015;313(12):1213-1214.
Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-362.
Topic: Endocrinology and Metabolism
Jin J. Specific Medications for Weight Loss. JAMA. 2015;314(7):742. doi:10.1001/jama.2015.5836