WEIGHT LOSS MEDICATIONS
Dr. Dyal is Board Certified in Obesity Medicine and can prescribe weight loss medications when appropriate. Very specific clinical guidelines are used to determine if appetite suppressants should be used in your weight loss plan and they are always used in combination with a low calorie diet, physical activity and behavior education rather than instead of them.
APPETITE SUPPRESSANT MEDICATIONS
There are currently 8 FDA approved medications for weight loss. They are indicated for use in combination with low calorie diet and increased physical activity intervention programs. In general, they are effective only while they are being taken and weight regain often occurs when you stop taking them so chronic use must be considered prior to starting these medications. It is essential that your weight management program include proper nutrition, physical activity and lifestyle habits for long term successful weight loss.
Guidelines for medication use include people with a body mass index (BMI) over 30 or BMI greater than 27 with other weight-related medical problems like high blood pressure, diabetes or high cholesterol. These medications act in different ways to help control hunger, suppress appetite or improve your metabolism. They can be used in your comprehensive weight management program when appropriate. Weight loss medication use must be followed closely. Effectiveness of and reactions to the medications are monitored regularly and medications adjusted or stopped in accordance with clinical guidelines to achieve the best outcome. There are circumstances in which weight loss medications may not be appropriate for use. Medications are prescribed at the discretion of our physician in collaboration with your primary care physician.
Phentermine
Phentermine is FDA-approved for short term (3 months) use in weight loss in people with a BMI > 30 or those with a BMI > 27 and weight-related medical conditions. However, many obesity medicine specialists use it safely for longer durations and even for long-term maintenance. It is a sympathomimetic and increases norepinephrine in the brain. The exact mechanism used to decrease hunger is unknown but its effect is to suppress appetite. Some side effects can include high blood pressure, headache, insomnia and nervousness.
Diethylpropion (Tenuate)
Diethylpropion (Tenuate) is FDA-approved for short term (3 months) use in weight loss in people with a BMI > 30 or those with a BMI > 27 and weight-related medical conditions. However, many obesity medicine specialists use it safely for longer durations and for long-term maintenance. It is a sympathomimetic with the shortest duration of activity and it also acts in the brain to suppress appetite. Some side effects can include high blood pressure, headache, insomnia and nervousness.
Phendimetrazine (Bontril)
Phendimetrazine (Bontril) is FDA-approved for short term (3 months) use in weight loss in people with a BMI > 30 or those with a BMI > 27 and weight-related medical conditions. However, many obesity medicine specialists use it safely for longer durations and for long-term maintenance. It is a sympathomimetic with a shorter duration of activity than phentermine. It acts in the brain to suppress appetite. Some side effects can include high blood pressure, headache, insomnia and nervousness.
Phentermine/Topiramate (Qsymia)
Phentermine/Topiramate (Qsymia) is FDA approved for long-term use in weight loss in people with BMI over 30 or BMI greater than 27 with other weight-related medical problems. It contains phentermine which is a sympathomimetic (above) and topiramate which also stimulates receptors in the brain. Together they act to suppress appetite. Some side effects include paresthesias, headache, dizziness, insomnia, constipation, high blood pressure, increased heart rate, distorted taste, short term memory loss. Topiramate can cause fetal harm and birth defects so it is essential for women to use a highly effective method of birth control and to monitor for pregnancy before starting this drug and monthly while on it.
Orlistat (Xenical, Alli)
Orlistat (Xenical, Alli) is FDA approved for long-term use in weight loss in people with BMI over 30 or BMI greater than 27 with other weight-related medical problems like high blood pressure, diabetes or high cholesterol. It blocks fat absorption in the GI system. Some side effects include decreased absorption of vitamins A, D, E and K, and gastrointestinal symptoms including abdominal discomfort, oily diarrhea, oily stools and increased flatulence.
Lorcaserin (Belviq)
Lorcaserin (Belviq) is FDA approved for long-term use in weight loss in people with BMI over 30 or BMI greater than 27 with other weight-related medical problems like high blood pressure, diabetes or high cholesterol. It works in the brain to bind specific serotonin receptors that help signal satiety and reduce appetite. Some side effects include headache, nausea, dizziness, fatigue and constipation.
Naltrexone/Bupropion (Contrave)
Naltrexone/Bupropion (Contrave) is FDA approved for long-term use in weight loss in people with BMI over 30 or BMI greater than 27 with other weight-related medical problems like. It is a combination of buproprion which stimulates the release of hormones in the brain that suppresses appetite and naltrexone which prevents the process from being shut off by the increased hormone levels. Some side effects include nausea, constipation, headache, vomiting and dizziness.
Liraglutide (Saxenda)
Liragludtide (Saxenda) is FDA approved for long-term use in weight loss in people with BMI over 30 or BMI greater than 27 with other weight-related medical problems like high blood pressure, diabetes or high cholesterol. It is a GLP-1 (Glucagon-Like Peptide 1) receptor agonist that acts in the gastrointestinal system and slows stomach emptying, decreases appetite, increases fullness and lowers blood sugar. Some side effects are nausea, vomiting and pancreatitis.