4. In adults with obesity or overweight with weight-related complications,
AGA suggests using phentermine-topiramate extended release (ER) with
lifestyle modifications, compared with lifestyle modifications alone.
(Conditional recommendation, moderate certainty evidence)
Implementation considerations:
• Because topiramate is effective for treating migraine headaches, phentermine-
topiramate ER may be preferentially used in patients with history of migraines.
• Phentermine-topiramate ER should be avoided in patients with a history of
cardiovascular disease and uncontrolled hypertension.
• Topiramate is teratogenic. Women of childbearing potential should be counseled to
use effective contraception consistently.
• Blood pressure and heart rate should be monitored periodically while taking
medications containing phentermine.
5. In adults with obesity or overweight with weight-related complications,
AGA suggests using naltrexone-bupropion ER with lifestyle
modifications, compared with lifestyle modifications alone. (Conditional
recommendation, moderate certainty evidence)
Implementation considerations:
• Naltrexone-bupropion ER may be considered for the treatment of overweight or
obesity in patients who are attempting smoking cessation, and in patients with
depression.
• Naltrexone-bupropion ER should be avoided in patients with seizure disorders and
used with caution in patients at risk of seizures.
• Naltrexone-bupropion ER should not be used concomitantly with opiate
medications.
• Blood pressure and heart rate should be monitored periodically while taking
naltrexone-bupropion ER, especially in the first 12 weeks of treatment.
6. In adults with obesity or overweight with weight-related complications,
AGA suggests against the use of orlistat. (Conditional recommendation,
moderate certainty evidence)
Comment: Patients who place a high value on the potential small weight loss benefit and
low value on gastrointestinal (GI) adverse effects may reasonably choose treatment with
orlistat.
Implementation considerations:
• Patients taking Orlistat should take a daily multivitamin containing fat-soluble
micronutrients (A, D, E, K) and should be taken 2 hours apart from orlistat.
• Patients should be monitored for the development of micronutrient deficiencies.
