Other drugs used for treating obesity

Drug and classIdeal candidatesSide effectsContraindicationsaAverage wholesale priceb
Lisdexam-fetaminec (amphetamine prodrug)Patients with attention deficit hyperactivity disorderInsomnia, 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/AHeadaches, 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 migrainesInsomnia, 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 prediabetesDiarrhea, nausea, abdominal pain. Serious but rare: lactic acidosis.Severe chronic kidney disease.$5
Pramlintidee,f (amylin analogue)Patients with type 1 or type 2 diabetesHypoglycemia, headaches, nausea, vomiting.Gastroparesis and hypoglycemic unawareness.$694
SGLT-2 inhibitorse,fPatients with type 2 diabetes, hypertension, heart failure, cardiovascular disease, diabetic kidney diseaseGenitourinary 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