SPECIALTY PROVIDERS

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Known as Orlistat, it is a pancreatic lipase inhibitor that was created to block intestinal absorption of fat. It was created for the indication of weight loss, and FDA approved in 1999.

ALSO KNOWN AS: Orlistat

AVOID WHEN: Chronic malabsorption; Pregnancy; Cholestasis/History of Gallbladder disease

SIDE EFFECTS: Oily Spotting (26%); Flatus with Discharge (23.9%); Fecal Urgency (22.1%); Fatty/Oily Stool (20.0%); Oily Evacuation (11.9%); Increased risk of Vitamin D, E, A, K deficiency

Orlistat works directly as a lipase inhibitor. By blocking the breakdown of fats in the intestines, fats cannot be absorbed and are excreted in stool.

Orlistat is associated with a modest reduction in weight: meta-analysis including 11 randomized control trials using 120mg of Orlistat 3 times per day showed 2.9% greater weight loss than placebo.

Metformin is an oral medication commonly prescribed for adults and children (aged 10 years and older) with type 2 diabetes. Here’s how it works:

ALSO KNOWN AS: Glucophage

AVOID WHEN: You have ever had an allergic reaction to metformin or other medicine; Have uncontrolled diabetes; Have liver or kidney problems; Have a severe infection; Are being treated for heart failure or have recently had a heart attack

SIDE EFFECTS: Nausea or vomiting; Diarrhea; Gas/GI discomfort; Headache; Weight loss (which can be a positive effect for those aiming to lose weight)

Metformin  regulates blood sugar levels by:

• Decreasing  sugar production by the liver.
• Reducing sugar absorption in the intestines.
• Increasing insulin sensitivity, allowing the body to use insulin
• Studies suggest that metformin may decrease appetite. It  does so by reducing levels of a hormone called leptin, which regulates appetite by signaling fullness to the brain. 

Tirzepatide is the newest form of weight loss medication. It was recently approved for Type 2 diabetes, and works through both the GLP-1 receptor and GIP receptors. Both of these work to slow stomach emptying and decrease appetite.

ALSO KNOWN AS: Tirzepatide

AVOID WHEN: Chronic malabsorption; Pregnancy; Cholestasis/History of Gallbladder disease; Pancreatitis; Family history of Thyroid Cancer; Thyroid disorders

SIDE EFFECTS: Nausea (44%); Vomiting (25%); Diarrhea/GI distress (30%)

Both GLP-1 and GIP receptors work to decrease the rate your stomach empties– keeping you full for longer! They also work to decrease your appetite and cravings.

Research Results

The SURMOUNT-1 trial showed expected weight loss of 22.5%. Additional trials have shown this medication is twice as effective as Semaglutide 1.0mg.

Phentermine is used for weight reduction in patients with obesity. It is used in patients with obesity who have not been able to lose weight with diet and exercise alone. This medicine works by suppressing your appetite. 

This medicine is available only with a controlled substance prescription.

ALSO KNOWN AS: Adipex P, Suprenza

AVOID WHEN: Pregnancy; Breast Feeding, Heart Disorders, ADHD, Elderly, Chronic Illness/Disease, Some Mental Health Disorders, review list online

SIDE EFFECTS: Dizziness, fainting, fast, irregular, or racing heartbeat, headache, numbness, swelling, trouble with thinking, speaking, or walking, weakness, chest pain

This medicine works by suppressing your appetite. It stimulates the release of the neurotransmitter, adrenaline (epinephrine), which stimulates the breakdown of stored fat. Therefore, Phentermine promotes weight loss by reducing appetite and increasing energy and boosting the breakdown of fat. 

Significant number of subjects in phentermine group versus placebo accomplished weight reduction of 5% or greater from the baseline. 

*CONTROLLED MEDICATION*

Liraglutide is a GLP-1 agonist medication, very similar to Semaglutide. It was initially developed as a medication for Type 2 Diabetes, but found to also help patients with weight loss! By activating GLP-1 receptors, this medication works to slow the rate at which your stomach empties, and to send signals to your brain to decrease appetite.

ALSO KNOWN AS: Liraglutide

AVOID WHEN: Pancreatitis Gallstones; Family history of Thyroid Cancer; Thyroid disorders

SIDE EFFECTS: Nausea (44%); Vomiting (25%); Diarrhea/GI distress (30%)

GLP-1 works to increase insulin levels by activating cells in the pancreas. It also triggers hormone release to delay the emptying of the stomach, sometimes causing nausea.

The SCALE Trial showed patients can lose 6.2% over 52 weeks (CI 7.5 to 4.6%).

Topiramate, a medication originally created to treat epilepsy, was approved by the FDA in 1998. It is used off-label for weight loss, often in conjunction with Phentermine. It can be used short- or long-term for weight loss safely.

ALSO KNOWN AS: Topiramate

AVOID WHEN: History of Kidney Stones; Pregnant; Breastfeeding; Trying to Conceive; History of Anorexia/Bulimia

SIDE EFFECTS: Dizziness (<1%); Paresthesias (5%); Anxiety (1.1%); Headache (1.7%)

Topiramate alters a variety of GABA and Glutamate channels in the brain to suppress cravings and appetite.

Topiramate has independently shown results in meta-analysis of 5.34kg weight loss (95% CI 4.56-6.12kg). In conjunction with Phentermine, the CONQUER and SEQUEL Trials Showed as high as 10.7% weight loss in low-dose and 14% in high-dose groups maintained over 2 years.

Naltrexone was developed as a medication for alcohol and substance use disorder. However, as its mechanism is to stop cravings, it has long been prescribed for weight loss. It is a component in the combination pill, Contrave.

ALSO KNOWN AS: Naltrexone

AVOID WHEN: History of Anorexia/Bulimia; Concurrent substance use disorder; Use of opiates; Pregnant; Breastfeeding; Trying to conceive

SIDE EFFECTS: Abdominal Pain (11%); Anxiety (12%); Headache (25%)

Naltrexone is a mu-receptor antagonist (blocker). This inhibits the effects on the hypothalamic-pituitary-adrenal axis from this receptor, and thus suppresses appetite and cravings.

Naltrexone has been studied both independently and as a component in Contrave (8.1-11.5% weight loss when used with Bupropion).

Semaglutide is a GLP-1 agonist created for Type 2 Diabetes and FDA approved in 2019. It was approved for the indication of weight loss as Wegovy in June 2021.

ALSO KNOWN AS: Semaglutide

AVOID WHEN: History of Thyroid C-cell tumors; Pregnant; Breastfeeding; Trying to conceive; History of anorexia/bulimia

SIDE EFFECTS: Nausea (44%); Vomiting (25%); Diarrhea/GI distress (30%)

GLP-1 works to increase insulin levels by activating cells in the pancreas. It also triggers hormone release to delay the emptying of the stomach, sometimes causing nausea.

When used alongside robust lifestyle management (200 min exercise/week, nutri-system diet, bimonthly nutritionist visits) patients observed 10-14% weight loss, maintained over 2 years (STEP3 Trial, Novo Nordisk).

Bupropion was initially approved as a medication for anxiety and depression. It is also used as a smoking cessation aid, as it reduces cravings and alters mood. It is prescribed off-label either alone or with Naltrexone for weight loss, and also as a combo pill (Contrave).

ALSO KNOWN AS: Wellbutrin XL, Wellbutrin SR, Forfivo XL, Bupropion

AVOID WHEN: History of Bipolar Disorder; Schizophrenia; Hypertension; Concurrent substance use disorder

SIDE EFFECTS: Activation of mania in bipolar patients (<1%); Insomnia (11-40%)

Bupropion works by inhibiting neurotransmitter reuptake of norepinephrine and dopamine. By holding higher concentrations of these in the brain, neurons increase signaling and alter hunger and mood.

Bupropion has been studied, both independently and in conjunction with Naltrexone (Contrave). The COR-I, COR-II, COR-BMOD, and COR-Diabetes trials demonstrated 8.1-11.5% weight loss over 2 years.