Drugs approved for long-term treatment of obesity
| Drug and class | Ideal candidates | Adverse effects | Contraindicationsa | Average wholesale priceb |
|---|---|---|---|---|
| Liraglutide Semaglutide (GLP-1 receptor agonist) | Patients with coronary artery disease, prediabetes, and diabetes | Constipation, diarrhea, nausea, headache, fatigue, and injection site reactions. Serious but rare: increased heart rate, renal impairment, pancreatitis, and suicidal ideation. Potential risk of thyroid C-cell tumor. Semaglutide is associated with an increased incidence of diabetic retinopathy complications, probably attributable to rapid correction of hyperglycemia in patients with diabetes. | Family or personal history of medullary thyroid cancer or multiple endocrine neoplasia type 2. Use with caution in patients with severe chronic kidney disease and history of pancreatitis. | Liraglutide $1,619 Semaglutide $1,022 |
| Naltrexone-bupropion (opioid receptor antagonist and DNRI) | Patients with depression, those interested in smoking cessation, and those with food addiction and strong cravings | Glaucoma, hepatotoxicity, increase in heart rate and blood pressure, headache, nausea, constipation, vomiting, dry mouth. Serious but rare: suicidal ideation and a lower seizure threshold. | Uncontrolled hypertension, seizures, anorexia, bulimia, drug or alcohol withdrawal, or chronic opioid use. | $365 |
| Orlistat (lipase inhibitor) | Patients who do not want to take a systemic drug, or patients who eat a moderate- or high-fat diet | Headaches, flatulence, cramping, fecal incontinence, oily spotting, decreased absorption of medications and fat-soluble vitamins. Gastric disturbances can be reduced by taking with psyllium. Serious but infrequent: liver injury, cholelithiasis, nephrolithiasis. | None, but not recommended for patients with malabsorption (eg, after gastric bypass surgery). | $108 |
| Phentermine-topiramate ERc (sympathomimetic amine and GABA receptor modulator) | Patients with chronic migraines | Increased heart rate, dizziness, neuropathy, insomnia, anxiety, depression, cognitive impairment, and dry mouth. Serious but rare: suicidal ideation, acidosis, hypokalemia, rise in serum creatinine, myopia, or glaucoma. Minimal risk of seizures with rapid discontinuation. | Uncontrolled anxiety or depression, cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, and history of substance dependence. | $239 |
↵a All antiobesity medications are contraindicated in pregnancy. Because of potential teratogenicity of many antiobesity drugs, a pregnancy test should be done before prescribing, and women should be counseled on effective birth control.
↵b Lexicomp average wholesale price for 30-day supply of maximum doses as of May 2021.
↵c A controlled substance.
DNRI = dopamine-norepinephrine reuptake inhibitor; ER = extended release; GABA = gamma aminobutyric acid; GLP-1 = glucagon-like protein-1