pharmacotherapy drugs ex 1

+ imp guidelines stuff

binge-eating disorder treatment

cognitive behavior treatment

lisdexamfetamine dimesylate FDA indicated

others: some SSRIs, topiramate & GLP-1s

Night-eating syndrome treatment

behavioral therapy regarding nutritional timing and content

Phentermine

sympathomimetic

reduce appetite

indicated for short-term use only (commonly 12 consecutive weeks)

Phentermine warnings & precautions

risk of abuse & dependence

CIs: cardiovascular dz, glaucoma, hyperthyroid, pregnancy/breastfeeding

phentermine ADRs

like excess catecholamines

overstimulation, palpitations, insomnia. HTN & tachycardia

orlistat

pancreatic lipase inhibitor

reduces fat absorption hence fewer inbound calories

Orlistat ADRs& CI

flatus w discharge, fecal urgency, fatty/ oily stool, oily evacuation, increased defecation & fecal incontinence

CI: may not be an options for pts with h/o nephrolithiasis (kidney stones)

orlistat counseling

generally mild and transient & decreased markedly during 2nd year of treatment

Onset (~24-48 h) depends on individual transit time

dosed within 1h of fatty meal

< 30% fat in diet may decrease GI effects

Phentermine/ topiramate ER

sympathomimetic anticonvulsant (GABA receptor modulation, carbonic anhydrase inhibition, glutamine antagonism)

reduces appetite

Phen/TPM ER

approved for chronic weight management

women must use birth control (REMS)- cleft palate

taper on initiation & discont (seizure risk)

CI: in glaucoma

monitor for metabolic acidosis, hypokalemia, & elevation in Scr

Naltrexone/ bupropion SR

opioid receptor antagonist; dopamine and norepinephrine reuptake inhibitor

reduces appetite

Naltrexone/ bupropion CIs

seizure disorders

bulimia or anorexia nervosa

chronic opioid or opiate agonist

naltrexone/ bupropion DDI & BW

DDI: drug interaction with CYP2B6 inhibitors (ex: ticlopidine or clopidogrel)

BW: suicidal ideations and neuropsychiatric symptoms

naltrexone/ bupropion ADRs

N/V/D

constipation, headache, dizziness, insomnia, dry mouth

GLP-1s

liraglutide, semaglutide, orflorglipron

reduce appetite

liraglutide- saxenda

3mg dose

more common GI SEs- nausea

concerns regarding gall bladder AE, pancreatitis, thyroid cancer

Semaglutide- wegovy

IM 2.4 mg dose, high dose 7.2 mg

PO 1.5 mg -9 mg, high dose 25 mg

FDA approval for obesity + ASCVD & MASH (F2-F3), 12+

CV benefit; kidney benefit; peripheral artery disease; liver disease benefit; heart failure benefit

Orforglipron-Foundayo

oral non-peptide GLP-1

absorption not dependent on SNAC

mean weight loss ~10-12%

nausea, constipation, diarrhea

Tirzepatide

GLP-1/GIP receptor agonist

reduce appetite

Tirzepatide-zepbound

same dosing as mounjaro up to 15mg weekly

mean weight loss 15-21%

FDA approved for obstructive sleep apnea; 18+

CV benefit; sleep apnea;liver disease benefit; heart failure benefit

Setmelanotide

melanocortin 4 receptor agonists

reduce appetite

Plenity

FDA approved device that’s the 1st non-systemic oral cap for weight management

Indicated for BMI 25-40

Made from cellulose and citric acid