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Weight-loss medicines

There are several different medicines used for weight loss. Before trying weight-loss medicines, your health care provider will have you try non-drug ways for losing weight. While weight-loss drugs can be helpful, the overall weight loss achieved is limited. In addition, it's likely the weight will be regained when the medicines are stopped.

Medicine Options

Several weight-loss medicines are available. About 5 to 10 pounds (2 to 4.5 kilograms) can be lost by taking these medicines. But not everyone loses weight while taking them. Most people also regain the weight after they stop taking the medicines, unless they have made lasting lifestyle changes, such as exercising and cutting unhealthy foods from their diets.

You may also see ads for herbal remedies and supplements that claim to help you lose weight. Many of these claims are not true. Some of these supplements can have serious side effects.

Note for women: Pregnant or nursing women should never take diet medicines. This includes prescription, herbal, and over-the-counter remedies. Over-the-counter refers to medicines, herbs, or supplements you can buy without a prescription.

The different weight-loss medicines are described below. Be sure to talk with your provider about which medicine is right for you.

ORLISTAT (XENICAL AND ALLI)

Orlistat works by slowing the absorption of fat in the intestine by about 30%. It is approved for long-term use.

About 6 pounds (3 kilograms) can be lost when using this medicine. But not everyone loses weight while taking it. Many people regain most of the weight within 2 years after they stop using it.

The most unpleasant side effect of orlistat is oily diarrhea that may leak from the anus. Eating less fatty foods can reduce this effect. Despite this side effect, most people tolerate this medicine.

Xenical is the brand of orlistat your provider can prescribe for you. You can also buy orlistat without a prescription under the name Alli. These pills are half the strength of Xenical. Orlistat costs about $100 or more a month. Consider whether the cost, side effects, and the small weight loss you can expect are worth it to you.

Your body may not absorb important vitamins, minerals, and other nutrients from food while you are using orlistat. You should take a daily multivitamin if you use orlistat.

MEDICINES THAT SUPPRESS THE APPETITE

These medicines work in your brain by making you less interested in food.

Not everyone loses weight while taking the medicines. Most people regain the weight after they stop taking the medicine, unless they have made lasting lifestyle changes. Talk with your provider about how much weight you can expect to lose by taking any of these medicines.

These medicines are available only by prescription. They include:

  • Phentermine (Adipex-P, Lomaira, Phentercot, Phentride, Pro-Fast)
  • Phentermine combined with topiramate (Qsymia)
  • Benzphetamine, Phendimetrazine (Bontril, Obezine, Phendiet, Prelu-2)
  • Diethylpropion (Tenuate)
  • Naltrexone combined with bupropion (Contrave)
  • Lorcaserin (Belviq)

Only lorcaserin and phentermine/topiramate are approved for long-term use. All other drugs are approved for short-term use of no more than a few weeks.

Side Effects

Be sure you understand the side effects of weight-loss medicines. Side effects can include:

  • Increase in blood pressure
  • Problems sleeping, headache, nervousness, and palpitations
  • Nausea, constipation, and dry mouth
  • Depression, which some people who are obese struggle with already

If You Have Diabetes

If you have diabetes that needs treatment with medicines, you may want to ask your provider about diabetes medicines that cause weight-loss. These include:

  • Canagliflozin (Invokana)
  • Dapagliflozin (Farxiga)
  • Dapagliflozin combined with saxagliptin (Qtern)
  • Empagliflozin (Jardiance)
  • Exenatide (Byetta, Bydureon)
  • Liraglutide (Victoza)
  • Metformin (Glucophage, Glumetza, and Fortamet) 

These medicines are not approved by the FDA to treat weight-loss. So you should not take them if you do not have diabetes.

Alternative Names

Prescription weight loss drugs; Diabetes - weight loss drugs; Obesity - weight loss drugs; Overweight - weight loss drugs

References

Apovian CM, Aronne LJ, Bessesen DH, et al.; Endocrine Society. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2);342-362. PMID: 25590212 www.ncbi.nlm.nih.gov/pubmed/25590212.

Jensen MD. Obesity. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 220.

Klein S, Romijn JA. Obesity. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016: chap 36.

Mordes JP, Liu C, Xu S. Medications for weight loss. Curr Opin Endocrinol Diabetes Obes. 2015;22(2):91-97. PMID: 25692921 www.ncbi.nlm.nih.gov/pubmed/25692921.

Review Date 5/21/2017

Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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