3
Treatment
➤ Phentermine is a sympathomimetic amine with possible
adrenergic side effects and contraindications in patients with
cardiovascular disease.
• Phentermine hydrochloride (HCl) 8–37.5 mg prescribed in the
U.S. is generally equivalent to 6.4–30 mg of phentermine resin
marketed outside the U.S.
• Although not consistent with the prescribing information
indicated use, phentermine administration for longer than 12
weeks is supported by clinical data and opinion leaders.
➤ Semaglutide is a GLP-1 RA indicated for BMI ≥30 kg/m
2
+
at least 1 obesity-related complication (ORC), BMI ≥27 kg/m
2
,
or children with obesity (age ≥12) with a BMI at or above the
95th percentile or ≥85th plus an ORC. It is contraindicated in
pregnancy, multiple endocrine neoplasia (MEN) type 2 and a
personal or family history of medullary thyroid cancer (CA).
➤ Liraglutide is a GLP-1 RA approved at 1.8 mg per day for treatment
of type 2 diabetes mellitus, and at 3.0 mg per day for treatment
of obesity with possible gastrointestinal side effects. It is also
indicated for children with obesity (age ≥12) with a BMI at or above
the 95th percentile or ≥85th plus an ORC. It is contraindicated
in patients with personal or family history of medullary thyroid
cancer or Type 2 MEN syndrome.
➤ Naltrexone/bupropion is a combination of an opioid antagonist
and antidepressant, with possible gastrointestinal side effects.
It is contraindicated in patients with uncontrolled hypertension,
chronic opioid use, seizure disorders, and abrupt discontinuation
of alcohol, benzodiazepines, barbiturates and antiepileptic drugs.
➤ Phentermine/topiramate is a combination of a sympathomimetic
amine and anti-seizure/migraine medication with side effects
that include paresthesias and dysgeusia. It is contraindicated in
women who may become pregnant.
➤ Liraglutide and phentermine/topiramate can be taken with or
without meals.
➤ Orlistat is a gastrointestinal lipase inhibitor with possible adverse
experiences that include oily rectal discharge and flatus. It is
contraindicated in patients with chronic malabsorption syndrome
and cholestasis.
➤ Orlistat should be taken three times a day with each meal that
contains fat. Bupropion/naltrexone should not be taken with high
fat meals due to increased absorption.
