With obesity on the rise, the FDA recently approved another weight-loss medication.
According to the US Centers for Disease Control and Prevention, more than one-third of US adults are obese. With obesity on the rise, the FDA recently approved another weight-loss medication.
Contrave was approved in late 2014 as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:
Contrave is a combination of naltrexone, an opioid antagonist, and bupropion, an antidepressant. The drug does require a 4-week dose titration schedule. Since it consists bupropion, it carries a black-box warning for Suicidality and Antidepressant Drugs, as well as Neuropsychiatric Reactions in Patients taking Bupropion for Smoking Cessation.
Counseling points for Contrave include:
Like Contrave, available weight-loss medications are approved as adjuncts to a reduced-calorie diet and increased physical activity.
Lorcaserin (Belviq) was approved in 2012 and is a serotonin 2C receptor agonist that is taken twice a day. Since Belviq works on serotonin, the risk for serotonin syndrome is present. That being said, pharmacists should be mindful of possible drug interactions with serotonergic medications.
Counseling points for Belviq include:
Also approved in 2012 was Qsymia, a combination of phentermine, a sympathomimetic amine anorectic, and topiramate extended-release, an antiepileptic medication. Qsymia is taken once daily in the morning with or without food. Since it contains topiramate, patients may notice concentration, memory, and speech difficulties.
Counseling points for Qsymia include:
For all of these weight-loss medications, response should be evaluated after 12 weeks at the maintenance dosage. If a patient has not lost a certain percentage (usually 5%) of baseline body weight, the weight-loss medication should be discontinued, as it is unlikely the patient will achieve and sustain clinically meaningful weight loss if treatment were to be continued.
Orlistat is available as both a prescription (Xenical) and an OTC product (Alli). Xenical and Alli are reversible inhibitors of gastrointestinal lipases.
Xenical is taken 3 times a day with each main meal containing fat (during or up to 1 hour after the meal).
Counseling points for Xenical and Alli include:
Phentermine has been available on the market since the 1950s in a variety of formulations. Phentermine is a sympathomimetic amine anorectic and is usually taken once a day in the morning.
Counseling points for phentermine products include: