Obesity Medications

    Cards (6)

    • Lipase inhibitor med info
      Orlistat (Xenical, Ali)
      • MOA: inhibit gastric and pancreatic lipase and reduces absorption of dietary fat by about 30%
      • AE: flatulence, oily spotting, fecal urgency/incontinence, bloating, and cramping all d/t malabsorption of fat
      • CI: chronic malabsorption syndromes, cholestasis, safety/efficacy not proven in pregnant/breastfeeding, hepatotoxicity
      • Pt. C: nonscheduled, associated w/ LDL reduction (double what's expected)
      • Use: approved for LONG term use (up to 4 years), about 2-3 kg weight loss
    • GLP-1 RA med info
      Liraglutide, Semaglutide (Wegovy, Ozempic)
      • MOA: analogues of human GLP-1 that increase insulin secretion, decrease glucagon secretion, reduce gastric emptying, and increase satiety
      • AE: n/v, diarrhea or constipation, pancreatitis (rare) or kidney dysfunction (rare)
      • CI: gastroparesis, hx of pancreatitis, pt w/ MENS2, family hx of medullary thyroid carcinoma, hypersensitivity
      • Pt. C: expensive, liraglutide = avg 5.8 kg loss at 1 year, semaglutide = avg 15 kg loss over 68 weeks
      • Caution: can reduce rate of absorptionof drugs that require rapid absorption so separate by 1 hour
    • GIP/GLP-1 RA med info
      Tirzepatide (Mounjaro)
      • MOA: agonist at BOT GIP and GLP-1 receptors resulting in same things as GLP-1 RA and may contribute to regulation of food intake
      • AE: same as GLP-1s
      • Pt. C: very expensive, avg 16-22 kg weight loss
      • Clinical: T2DM, chronic obesity
    • Anorexiants (Sympathomimetics)
      Phentermine (Adipex P)
      • MOA: increase norepinephrine and dopamine release, lead to stimulation of CNS, BP elevation and appetite suppression
      • AE: dry mouth, HA, insomnia, constipation, increase HR and BP, pulm. HTN and valvular HD
      • CI: use of MAOI within 14 days, hx of CVD, HF, arrhythmias, stroke, pulm. HTN, glaucoma, hyperthyroidism, substance abuse, PREGNANCY
      • Pt.C: 3-4 kg loss, can have withdraw sx (fatigue, depression) if abrupt stop, tell pt to avoid caffeine or other CNS stimulants and report new angina, dysrhythmia, CVA, syncope, dyspnea or edema
    • Phentermine/Topiramate ER info
      • MOA: phentermine = sympathomimetic effects, topiramate = unknown, effects on appetite suppression and satiety enhancement via neurotransmitter effects
      • AE: paresthesia, dry mouth, headache, insomnia (avoid evening dose), constipation, increased heart rate, increased BP, pulmonary HTN and valvular heart disease
      • CI: same as phentermine
      • Pt. C: avg 6.6-8.6 % loss after 1 year, renal and hepatic dose adjustments
      • Use: chronic mgmt of weight loss, start low and titrate up
    • Naltrexone/Burpropion ER
      • MOA: affect two areas of brain that regulate food intakehypothalamus (appetite regulation) and mesolimbic dopamine circuit (reward system); Naltrexone = opioid antagonist, Bupropion = dopamine and norepi reuptake inhibitor
      • AE: n/v, constipation, HA, dizzy, increased BP and HR
      • CI: buprop is a cYP2D6 inhibitor, uncontrolled HTN, seizure disorder, anorexia/bulimia, drug/alcohol withdrawal, chronic opioid use, MAOIs
      • BBW: suicidal thoughts and behaviors, neuropsychiatric reactions
      • Use: start low and icnrease dose, d/c if don't achieve 5% wt loss after 12 weeks
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