Obesity medications

Indication for orlistat

long-term weight loss and weight management in conjunction with a reduced-calorie diet; risk reduction of weight gain after prior weight loss

MOA of orlistat

• pancreatic lipase inhibitor that prevents the absorption of triglycerides in the intestine

• lowers serum glucose levels and improves insulin sensitivity, BP, LDL, and total cholesterol A

Dosing of orlistat

60 mg OTC for adults or 120 mg TID with each meal containing fat

Counseling point with orlistat

Patients should be advised to take a multivitamin to counteract decreased absorption of fat-soluble vitamins

ADR of orlistat

• fecal urgency and incontinence

• oily stool

Drug interactions with orlistat

• cyclosporine

• levothyroxine

• warfarin

• amiodarone

• antiepileptic agents

• antiretroviral

MOA of sympathomimetic amines

acts as an appetite suppressant by inhibiting adrenaline reuptake

Contraindications for orlistat

• pregnancy

• chronic malabsorption syndrome

• cholestasis

Contraindications for sympathomimetics

• pregnancy

• anxiety disorders

• uncontrolled HTN

• hx of heart disease

• hyperthyroidism

• glaucoma

• epilepsy

• hx of drug abuse

• concurrent use with MAO inhibitors

What are the 2 main sympathomimetic amines?

1. phentermine

2. diethypropion

Phentermine and diethylpropion are schedule ____ drugs

4

Benzphetamine and phendimetrazine are schedule ____

3

What is Qsymia?

phentermine/topiramate ER

What does topiramate do?

help promote taste aversion and decreased caloric intake

Starting dose of Qsymia

3.75mg/23mg

Recommended dose of Qsymia

7.5mg/46mg

Titration dose of Qsymia

11.25mg/69mg

Max dose of Qsymia

15mg/92mg

ADR of Qsymia

• paresthesia

• dizziness

• dysgeusia

• insomnia

• constipation and dry mouth

Contraindications with Qsymia

• glaucoma

• hyperthyroidism

• 14 days of MAOi

• pregnant or planning to become

What is Contrave?

Naltrexone SL/ Bupropion SR

What does the dosing titration of Contrave look like

Week 1- tablet in Am

Week 2- tablet in AM and PM

Week 3- 2 tabs in AM and 1 PM

Week 4 and up- 2 tabs AM and 2 PM

Tablet strength of Contrave

8mg/90mg

ADR of Contrave

• HA

• NVD

• Dry mouth

• insomnia

• constipation

Contraindications of Contrave

• uncontrolled HTN

• seizure d/o

• eating disorders

• alcohol, benzos, barbs

• MOAi

• pregnancy

Liraglutide’s brand name

Saxenda

What is the recommended dose of liraglutide for tx of obesity

3mg QD with or without food

What is the dosing titration of liraglutide

increase 0.6mg each week

Maintenance dose of semaglutide

2.4mg

Administer Wegovy (daily/weekly)?

weekly

With Wegovy, dose escalate every ___ weeks until reaching maintenance dose

4

What makes Tirzepatide different from Wegovy

GLP-1 and GIP

What are some long term effects of GLP-1 and GIP/GLP-1RA

• Osteoporosis and fracture risk

• muscle mass reduction

• nutritional deficiencies

Drugs to consider in patients >65 yo

• liraglutide

• semaglutide

• phentermine/topiramate

Medications to use in CVD

• liraglutide

• orlistat

• semaglutide

Medications to use in depression

• liraglutide

• naltrexone/bupropion

• orlistat

• phentermine/topiramate

Medications to use in patients with hx of MTC or pancreatitis

• naltrexone/bupropion

• orlistat

• phentermine/topiramate

Medications to use in NAFLD

• liraglutide

• orlistat

• semaglutide

Medications to use in obstructive sleep apnea

• liraglutide

• orlistat

• phentermine/topiramate

Medications to use in opioid use or hx of seizure

• liraglutide

• orlistat

• phentermine/topiramate

• semaglutide