Other drugs used for treating obesity
Drug and class | Ideal candidates | Side effects | Contraindicationsa | Average wholesale priceb |
---|---|---|---|---|
Lisdexam-fetaminec (amphetamine prodrug) | Patients with attention deficit hyperactivity disorder | Insomnia, irritability, anxiety, dry mouth, increased heart rate and blood pressure. Controlled substance with theoretical potential for abuse and dependence. | None, but we recommend against using in patients with cardiovascular disease. | $402 |
Phentermined (sympathomimetic amine) | N/A | Headaches, increased blood pressure and heart rate, irritability, insomnia, constipation, diarrhea, impotence, dizziness. Controlled substance with theoretical potential for abuse and dependence. Serious but rare: pulmonary hypertension, valvular disease. | Uncontrolled anxiety and hypertension, cardiovascular disease, hyperparathyroidism, glaucoma, and history of drug dependence. | $21.30 |
Topiramatee (GABA receptor modulator) | Patients with chronic migraines | Insomnia, xerostomia, constipation, paresthesias, dizziness, anxiety, depression, drowsiness, language and memory impairments. Very rare: seizures with rapid discontinuation. | Hyperthyroidism, glaucoma. | $10 |
Metformine,f (biguanide) | Patients with diabetes and prediabetes | Diarrhea, nausea, abdominal pain. Serious but rare: lactic acidosis. | Severe chronic kidney disease. | $5 |
Pramlintidee,f (amylin analogue) | Patients with type 1 or type 2 diabetes | Hypoglycemia, headaches, nausea, vomiting. | Gastroparesis and hypoglycemic unawareness. | $694 |
SGLT-2 inhibitorse,f | Patients with type 2 diabetes, hypertension, heart failure, cardiovascular disease, diabetic kidney disease | Genitourinary infections, hypovolemia, increased low-density lipoprotein cholesterol, and hyperkalemia. Serious but rare: diabetic ketoacidosis, bone fractures, amputations, Fournier gangrene. | Severe chronic kidney disease and ketogenic diet (concern for euglycemic ketoacidosis). | $600-$700 |
↵a All antiobesity medications are contraindicated in pregnancy except for metformin in patients with diabetes. Because of the potential teratogenic effect of many antiobesity medications, a pregnancy test should be obtained 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 Approved for treatment of binge-eating disorder.
↵d Approved for short-term use; however, it is often prescribed long-term in US states where this regulation is not strictly enforced.
↵e Off-label use.
↵f Occasionally prescribed for patients who do not have diabetes or another US Food and Drug Administration indication for their use; however, this is not our practice.
GABA = gamma aminobutyric acid; SGLT-2 = sodium-glucose cotransporter-2