Medications Prescribed at Mochi

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Phentermine

Phentermine is a sympathomimetic medication that works to provide weight loss by suppressing appetite. Having been approved by the FDA since 1959, it is prescribed to over 1M adults per year in the US. It is approved for short term use upto 12 weeks, however can be used safely long-term (off-label) in patients who are able to maintain at least 5% weight loss.

ALSO KNOWN AS

Adipex, Phentermine HCl, Qsymia, Suprenza

PRICING

$15/month

AVOID WHEN

Cardiac History; Pregnant; Breastfeeding; Trying to Conceive; Severe Anxiety; History of Anorexia/Bulimia

SIDE EFFECTS

Anxiety (1.1%); Headache (1.7%) Rapid Heart Rate (<1%)

How It Works

Phentermine works by activating the sympathetic nervous system to increase metabolism and suppress appetite. These two mechanisms work together to both increase total daily energy expenditure and decrease food cravings.

Expected Results

Phentermine has been shown to maintain weight loss of 7.4% over 12 months, and between 10-14% when used in conjunction with Topiramate over 2 years (CONQUER and SEQUEL Trials). Most patients who find this effective will see at least 5% weight loss in the first 3 months of use.

Lewis, K.H., Fischer, H., Ard, J., Barton, L., Bessesen, D.H., Daley, M.F., Desai, J., Fitzpatrick, S.L., Horberg, M., Koebnick, C., Oshiro, C., Yamamoto, A., Young, D.R. and Arterburn, D.E. (2019), Safety and Effectiveness of Longer-Term Phentermine Use: Clinical Outcomes from an Electronic Health Record Cohort. Obesity, 27: 591-602.
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Topiramate

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

Topamax, Qudexy XR, Trokendi XR

PRICING

$25/month

AVOID WHEN

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

SIDE EFFECTS

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

How It Works

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

Expected Results

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.

Alberto Verrotti, Alessandra Scaparrotta, Sergio Agostinelli, Sabrina Di Pillo, Francesco Chiarelli, Salvatore Grosso. Topiramate-induced weight loss: A review, Epilepsy Research, Volume 95, Issue 3, 2011, Pages 189-199, ISSN 0920-1211. https://www.sciencedirect.com/science/article/pii/S0920121111001343. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-789X.2010.00846.x.
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Bupropion

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, Aplenzin, Zyban, Contrave

PRICING

$25/month

AVOID WHEN

History of Bipolar Disorder; Schizophrenia; Hypertension; Concurrent substance use disorder

SIDE EFFECTS

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

How It Works

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.

Expected Results

Bupropion has been studied extensively, 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.

Anderson, J.W., Greenway, F.L., Fujioka, K., Gadde, K.M., McKenney, J. and O'Neil, P.M. (2002), Bupropion SR Enhances Weight Loss: A 48-Week Double-Blind, Placebo- Controlled Trial. Obesity Research, 10: 633-641. https://doi.org/10.1038/oby.2002.86. Jain, A.K., Kaplan, R.A., Gadde, K.M., Wadden, T.A., Allison, D.B., Brewer, E.R., Leadbetter, R.A., Richard, N., Haight, B., Jamerson, B.D., Buaron, K.S. and Metz, A. (2002), Bupropion SR vs. Placebo for Weight Loss in Obese Patients with Depressive Symptoms. Obesity Research, 10: 1049-1056. https://doi.org/10.1038/oby.2002.142
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Naltrexone

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

Vivitrol, Apo-naltrexone, ReVia

PRICING

$25/month

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%)

How It Works

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

Expected Results

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.

Sherman, M. M., Ungureanu, S., & Rey, J. A. (2016). Naltrexone/Bupropion ER (Contrave): Newly Approved Treatment Option for Chronic Weight Management in Obese Adults. P & T: a peer-reviewed journal for formulary management, 41(3), 164–172.
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Orlistat

Orlistat 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

Alli, Xenical

PRICING

$15/month

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

How It Works

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.

Expected Results

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.

Drew, B. S., Dixon, A. F., & Dixon, J. B. (2007). Obesity management: update on orlistat. Vascular health and risk management, 3(6), 817–821. FDA.
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Semaglutide

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

Wegovy, Ozempic, Rybelsus

PRICING

$1100/month

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%)

How It Works

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.

Expected Results

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).

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183.
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Liraglutide

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

Victoza, Saxenda

PRICING

$1000/month

AVOID WHEN

Pancreatitis Gallstones; Family history of Thyroid Cancer; Thyroid disorders

SIDE EFFECTS

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

How It Works

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.

Expected Results

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

Wadden, T., Hollander, P., Klein, S. et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: The SCALE Maintenance randomized study. Int J Obes 37, 1443–1451 (2013). https://doi.org/10.1038/ijo.2013.120
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Tirzepatide

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

Mounjaro

PRICING

$500/month

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%)

How It Works

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.

Expected 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.

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2206038.
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