Treatment
26
Table 5. Medications Studied for the Long-Term Treatment
of Obesity (cont'd)
Drug Status
Common Side
Effects
Monitoring and
Contraindications
Drugs Affecting Internal Milieu/Metabolic Control
Metformin
a
is drug is not
FDA approved
for obesity. It is
approved for ≥10
years of age for
T2DM
Nausea, flatulence,
bloating, diarrhea;
usually resolves
Do not use in renal
failure or with IV
contrast. MVI
supplementation is
strongly recommended.
Potential risk for
vitamin B12 deficiency
when used long-term.
Avoid alcohol intake.
Octreotide
(for
hypothalamic
obesity)
a
is drug is not
FDA approved for
obesity
Cholelithiasis (can
be prevented by
concurrent ursodiol),
diarrhea, edema,
abdominal cramps,
nausea, bloating,
reduction in T4
concentrations,
decreased GH but
normal IGF-I
Monitor fasting glucose,
FT4, HbA1c. Useful
only for hypothalamic
obesity. Ursodiol
coadministration is
strongly recommended.
Recombinant
human GH
a
is drug is not
FDA approved for
obesity. It is FDA
approved in Prader-
Willi syndrome
to increase height
velocity.
Edema, carpal
tunnel syndrome,
death in patients
with preexisting
obstructive sleep
apnea
GH should be used only
aer screening to rule out
obstructive sleep apnea in
patients with Prader-Willi
syndrome. Clinicians
must closely monitor
pulmonary function,
adrenal function, glucose,
HbA1c.
Note: All agents are contraindicated in pregnancy. See full prescribing information for all
adverse effects, cautions, and contraindications. Pharmacotherapy is not usually considered if
the BMI is below the 95th percentile, but there are additional factors to consider. If we initiate
pharmacotherapy early in the course of obesity, we may prevent extreme weight gain and metabolic
complications, but we may treat an excess of children and adolescents, raise the rate of unwarranted
side effects, and increase the costs to individuals and to society. Alternatively, if we begin medication
late in the course of obesity, we run the risk of runaway weight gain and long-term morbidity.
One approach that reconciles these difficulties is to act aggressively with lifestyle intervention in
overweight and mildly obese patients to prevent extreme obesity and to consider pharmacotherapy
when the risk of complications is high or soon aer complications emerge. e tipping point for
pharmacotherapy could be if the family history is strongly positive for a major comorbidity. Lifestyle
intervention should precede pharmacotherapy and should be maintained during pharmacotherapy.
Derived from August et al. J Clin Endocrinol Metab. 2008;93:4576–4599.
a
e use for obesity treatment in children and adolescents <16 years of age of these non–FDA-
approved agents should be restricted to large, well-controlled studies.
