Drugs approved for long-term treatment of obesity

Drug and classIdeal candidatesAdverse effectsContraindicationsaAverage wholesale priceb
Liraglutide Semaglutide (GLP-1 receptor agonist)Patients with coronary artery disease, prediabetes, and diabetesConstipation, 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 cravingsGlaucoma, 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 dietHeadaches, 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 migrainesIncreased 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