Common Medication Options for your Weight Loss Program
Pros
- Affordable: ~$15/month based on GoodRx pricing.
- Most commonly prescribed medication for weight loss.
Cons
- Only FDA approved for short-term (<12 weeks use). However, observational studies have been done for up to 2 years that show safety with extended use of medication.
Side Effects
- Increased heart rate, increased blood pressure, insomnia, dry mouth, constipation, nervousness.
Contraindications
- Heart disease, uncontrolled hypertension, pulmonary hypertension, history of addiction or drug abuse, hyperthyroidism, glaucoma, agitated states, pregnancy, breast feeding.
Liraglutide (Saxenda)
Pros
- Helps control diabetes.
Cons
- Requires a daily injection.
- Expensive: ~$1000/month based on GoodRx pricing.
Side Effects
- Nausea, vomiting, diarrhea, constipation, low blood sugar, pancreatitis, possible increased risk of thyroid cancer.
Contraindications
- Pregnancy, personal or family history of medullary thyroid cancer or multiple endocrine neoplasia 2A or 2B.
Orlistat
Pros
- Has been studied for long-term usage.
Cons
- Frequently not tolerated due to side effects.
- Medication needs to be taken 3 times a day along with a multivitamin at night.
- Can cause malabsorption of fat-soluble vitamins.
- Expensive: ~$700/month based on GoodRx pricing.
Side Effects
- Cramps, flatulence, fecal incontinence, oily spotting in underwear, oxalate-induced acute kidney injury, rare cases of severe liver injury..
Contraindications
- Pregnancy.
Topiramate (Topamax)
Pros
- Affordable: ~$3/month in some cases.
- Can also be used for migraine prevention and treatment of seizures..
- Is a good option for individuals with high blood pressure.
Cons
- Topiramate can have serious effects on a developing fetus, causing orofacial clefts in infants exposed to medication during 1st trimester of pregnancy. Therefore, if you have childbearing potential you need to do a pregnancy test prior to start of medication and monthly during treatment and use 2 different forms of contraception.
- Topiramate requires blood work for monitoring of side effects. You will have your electrolytes and creatinine checked before starting and approximately 4 weeks after starting to evaluate for a condition called hyperchloremic, non-anion gap metabolic acidosis.
- You need to wean off topiramate over at least a 1-week period to reduce risk of having a withdrawal seizure.
Side Effects
- Depression, anxiety, cognitive disturbances, abnormal nerve sensations, dry mouth, taste disturbance, constipation, kidney stones.
Contraindications
- Pregnancy, glaucoma.
Bupropion (Wellbutrin)
Pros
- Affordable: ~$5/month in some cases.
- Can also be used for treatment of depression and smoking cessation.
Cons
- Two different forms, the cheaper version is usually taken twice a day.
- Bupropion can increase the risk for seizures in persons predisposed to seizures.
- Like all antidepressants, patients with unmanaged bipolar disorder may develop mania.
- Like all stimulants, patients may develop dry mouth, insomnia, anxiety/nervousness or agitation.
Side Effects
- Increased heart rate, increased blood pressure, anxiety, exacerbation of psychosis, dry mouth, constipation, cognitive impairment.
Contraindications
- Seizure disorders, glaucoma.
Phentermine-Topiramate (Qsymia)
Pros
- More affordable than some options: ~$220/month based on GoodRx pricing.
- Has been studied for long-term usage.
Cons
- Complicated dosing regimen: Up to 4 different doses of medication may need to be adjusted over a 14-week period to achieve desired weight loss effect.
- Refer to individual medication components in handout for list of Cons on Phentermine and Topiramate.
Side Effects
- Refer to individual medication components in handout for list of Side Effects on Phentermine and Topiramate.
Contraindications
- Refer to individual medication components in handout for list of Contraindications on Phentermine and Topiramate
Bupropion-naltrexone (Contrave)
Pros
- Good option for an overweight smoker,
- More affordable than most options: ~$130/month based on GoodRx pricing.
Cons
- Studies have shown possible increased risk of a cardiovascular event from medication usage
- Slightly complicated dosing regimen ranging from 1 tablet of naltrexone-bupropion a day up to 2 tablets twice a day
Side Effects
- Nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth.
Contraindications
- Uncontrolled hypertension, glaucoma, seizure disorder, eating disorder, chronic opiate use, pregnancy, or breastfeeding.
