Module 8 Unit E Drug Table_ Anti-obesity Medications-1 (1)
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Jan 9, 2024
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Module 8 Unit E:
Anti-Obesity Medications (AOMs)
Class
Drug examples
Indications
MOA
Safety considerations/contr
aindications/
D2D
BBW
Special Anorexiant, CNS Stimulant, Sympathomimetic
diethylpropion
phentermine
weight loss - short-term (3 mos)
CNS stimulants that promote weight loss by ↓ appetite by ↑ norepinephrine availability at receptors in the brain
Hypersensitivity or idiosyncrasy to sympathomimetic amines; advanced arteriosclerosis, severe hypertension;
pulmonary hypertension; hyperthyroidism; glaucoma; agitated states, history of drug abuse; during or within 14 days following MAO inhibitor therapy, concurrent use with other anorectic agents
Tachycardia, angina,
HTN
Can exacerbate anxiety, nervousness, insomnia
Controlled substance, check local prescribing rules, Schedule IV
Phentermine is used more often than diethylpropion
Good choice for validated slow metabolism (via testing resting metabolic rate)
Anorexient/ Anticonvulsant, Sympathomimetic
Phentermine /topiramate (Qsymia)
weight loss and management
See phentermine above. Topiramate is thought to ↑ satiety by ↓ glutamate, carbonic anhydrase, and gamma-
aminobutyric acid.
CI: Glaucoma, hyperthyroid, pregnancy
Caution with hepatic impairment and HTN
HTN, tachycardia, birth defects, acute myopia in angle-
closure glaucoma, acidosis, impairment of memory and/or concentration.
Dry mouth, altered taste, constipation, blurred vision, dizziness, insomnia, some reports of numbness/tingling in extremities, Good choice for patients who struggle with feeling full after meals (always hungry).
Satiety is the feeling of fullness after completing a meal. Satiation is the feeling of fullness that leads to finishing a meal
Expect a 10% loss of TBW and ↓ BP over 56 weeks
GLP-1 Receptor Agonist
liraglutide (Saxenda, Victoza)
semaglutide (Wegovy, Ozempic)
Weight loss and management Activates receptors for GLP-1, causing ↓ gastric emptying, ↑ glucose-
dependent release of insulin, ↓ glucagon release. Centrally acting appetite suppression. May
↑ # beta cells
pregnancy: risk of fetal harm
Hypersensitivity
hypoglycemia (dose-
dependent) and usually with other hypoglycemic meds, GI s/s nausea, vomiting, diarrhea, constipation, pancreatitis, renal insufficiency, increased risk for CA:
medullary thyroid and theoretical risk with multiple Risk of thyroid C-cell tumors:
In rodents, semaglutide causes dose-dependent and treatment-duration-
dependent thyroid C-
cell tumors at clinically
relevant exposures.
Semaglutide is contraindicated in patients with a personal
or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN
SQ injections
Titrate up slowly to minimize adverse effects. Liraglutide requires daily dosing; semaglutide is dosed weekly.
endocrine neoplasms (MENs)
May increase HR.
Some postmarketing reports of fatigue, HA, weakness
2). Anorexiant, Antidepressant, Dopamine/Norepi
nephrine-
Reuptake Inhibitor, Opioid Antagonist
naltrexone and
bupropion (Contrave)
Promoting and maintaining weight loss
Unknown MOA. Theoretical action regulation of appetite
through action in the hypothalamus and mesolimbic dopamine system (reward system)
CI: any other bupropion-
containing medications, opioid analgesics
(will ↓analgesia),
or within 14 days
of MAOI
Nausea, vomiting, constipation, HA, dizziness, insomnia, ↑BP, dry mouth, diarrhea, anxiety,
fatigue, GI discomfort
Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults.
Increased risk of severe
neuropsychiatric reactions when given to
patients who are taking or discontinuing (weaning) off bupropion. In patients of all ages who are started on Contrave, monitor closely for worsening and for the emergence of suicidal thoughts and behaviors
It helps decrease appetite and curb cravings (think late-night snackers, stress eaters)
Lipase Inhibitor
Orlistat (OTC-Alli and by Rx-
Xenical)
Promoting and maintaining weight loss Acts in the GI tract to reduce the absorption of fat via the irreversible inhibition of gastric
and pancreatic lipase (up to 30% reduction of ingested fats)
CI: malabsorption syndrome or cholestasis
GI: oily stools, flatulence (with discharge), rectal leakage of oily discharge, fecal incontinence, increased BMs.
Reduced absorption of fat-soluble vitamins A, D, E, K
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Rare liver damage, pancreatitis, kidney stones
Can reduce the absorption of medications like levothyroxine, cyclosporine
Note: Locaserin was removed from the US market
due to concerns about increased cancer risk in 2/20