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Everything you need to know about anti-obesity drugs


By Cheshire Que, RND, RN, RD

It is true that losing weight is a result of energy or calorie deficit. If you burn more calories than you take in, you will eventually lose weight. Unfortunately, there are some factors that make losing weight much harder than it already is. Certain disorders of the endocrine system, some medications and psychosocial factors promote weight gain and may be potential barriers to the treatment of obesity.

Here are the list of medications that may cause weight gain:

For the treatment of diabetes, insulin, thiazolidinediones (rosiglitazone, pioglitazone), and sulfonylureas (glipizide, glyburide, glimepiride, chlorpropamide, tolbutamide) may cause up to eight kilograms of weight gain in an intensive three-month course of treatment.

Corticosteriods for polymyalgia rheumatic caused two to 13 kilograms weight gain in more than 50 percent of patients receiving a daily prednisone dose for one year.

Progestational steroids (Depot medroxyprogesterone acetate or DMPA) for contraception.

Antihistamines used to treat allergies (diphenhydramine)

Alpha-adrenergic blockers (prazosin, doxazosin, terazosin) and beta-adrenergic blockers (propranolol, metroprolol, atenolol) for hypertension and irregular heart rhythms.

For psychiatric or neurologic treatments, tricyclic antidepressants or TCAs (amitriptyline, doxepin, imipramine, nortriptyline, trimipramine, maprotiline, mirtazapine) generally cause 0.4 to 4.12 kilograms weight gain per month. Selective serotonin reuptake inhibitors or SSRIs (fluoxetine, sertraline, paroxetine, fluvoxamine) initially promote weight loss followed by weight gain within six months in some patients. Monoamine oxidase inhibitors or MAOIs (phenelzine, tranylcypromine) also show some weight gain with long term use of phenelzine. Lithium treatment show gains of up to 10 kilograms or more in six to 10 years.

Antipsychotics that most likely cause weight gain are clozapine, haloperidol, loxapine, olanzapine, risperidone, quetiapine, valproate, semisodium, and ziprasidone.

Anticonvulsants like pregabalin and valproic acid have variable weight gains of up to 15 to 20 kilograms.

If you are on any of these medications and are having weight issues, talk to your physician and seek the help of a registered dietitian for proper lifestyle and weight management.

But what if your weight goals are difficult to achieve despite proper diet and increased regular physical activity? What if you have done everything within your power yet nothing seems to work? What do you do when all else fails? Isn’t there a miracle pill that you can pop into your mouth and voila! You are 10 lbs lighter?

Well, there are six FDA approved medications for weight loss to date. Consult your physician regarding pharmacotherapy, which could be prescribed for the long term in conjunction with diet, regular physical activity, and behavior modification.

These medications are not for everyone wanting to lose weight. The indications for use are having a BMI of greater than or equal to 30 (obese) or BMI greater than or equal to 27 (overweight) with co-morbidities, defined as the simultaneous presence of two chronic diseases in a patient. Medications must be discontinued if weight loss is less than 12 lbs in 12 weeks because it is considered not as effective.

The following are the FDA approved medications for weight loss:

Orlistat – inhibits the enzyme lipase for fat absorption. This drug has unpleasant side effects such as foul smelling flatus, fatty stools, or steatorrhea due to fat malabsorption and stoll leakage. Supplementation of fat soluble Vitamins A, D, E, and K is required.

Phentermine – works in the hypothalamus part of the brain to curb appetite by releasing norephinephrine. This neurotransmitter and hormine may also increase energy expenditure and may be used to treat increased hunger, post menopausal women having weight problems and low resting metabolic rate. This drug is contraindicated for individuals with cardiovascular diseases, uncontrolled hypertension, irregular heart rhythms, hyperthyroidism, seizures, anxiety, panic attacks, bipolar disorder, and addiction. This must be taken early in the day to prevent sleep disturbance. Caffeine, energy drinks and nasal decongestant must be avoided. Watch out for palpitations, jitteriness, insomnia, constipation, eye pain, high blood pressure, and increased heart rate.

Phentermine/Topiramate – is a combination drug that reduces appetite and food craving.

Lorcaserin – activates the serotonin 2C receptor in the brain to decrease hunger and increase satiety. Adverse effects include irregular heartbeat, diarrhea, nausea, and agitation.

Bupropion and Naltrexone – are combined to help lessen appetite and curb cravings by blocking certain receptors in the brain. Adverse effects are nausea, headache, constipation, vomiting, dizzeness, insomnia, diarrhea, and dry mouth.

Liraglutide – an injectible derivatve of the metabolic hormone incretin used for diabetes and obesity treatment. Adverse effects are nausea, hypoglycemia or low blood glucose level, diarrhea, constipation, vomiting, headache, dizziness, and fatigue.

It is best to let a duly licensed health professional to guide you with weight management. Never self medicate or experiment. It is, after all, better to be safe than sorry.


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