Antiobesity drugs in the management of type 2 diabetes: A shift in thinking?

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FIGURE 1
Therapeutic algorithm for patients with obesity and type 2 diabetes mellitus.

TABLE 1

Drugs approved by the US Food and Drug Administration for treatment of obesity^a

Drug	Mechanism of action	Effect	Daily dosage^b
Orlistat (Xenical)	Inhibits pancreatic and gastric lipase	Decreases fat absorption	120 mg 3 times a day with each main meal containing fat
Phentermine (Adipex-P, Lomaira)	Augments central norepinephrine release	Decreases appetite	8 mg to 37.5 mg once daily
Phentermine and topiramate-extended release (Qsymia)	Augments central norepinephrine and gamma-amino butyric acid release	Decreases appetite	Phentermine 3.75 mg/topiramate 23 mg once daily (initial); phentermine 7.5 mg/ topiramate 46 mg once daily (maintenance)
Bupropion and naltrexone sustained release (Contrave)	Inhibits dopamine and norepinephrine reuptake; blocks opioid receptor	Decreases appetite	1 tablet (bupropion 90 mg/naltrexone 8 mg) once daily in morning (intial); 2 tablets (bupropion 180 mg/naltrexone 16 mg) twice daily (usual); maximum daily dose: bupropion 360 mg/naltrexone 32 mg
Diethylpropion (Tenuate, Tenuate Dospan)	Augments central norepinephrine release	Decreases appetite	25 mg 3 times a day (immediate release); 75 mg once daily, midmorning (controlled release)
Lorcaserin (Belviq)	Activates serotonin 5-HT receptor 2C	Decreases appetite	10 mg twice a day (immediate release)
Liraglutide (Saxenda) receptor	Activates glucagon-like peptide 1	Decreases appetite	3 mg subcutaneously once a day