Topamax / Qudexy XR / Trokendi XR
Description
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: 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.
Zyban / Contrave / Aplenzin
Description
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%)
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.
Vivitrol / Apo-Naltrexone /ReVia
Description
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%)
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.
Xenical / Alli
Description
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: 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
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.
Wegovy / Ozempic / Rybelsus
Description
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%)How It Works
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).
Saxenda / Victoza
Description
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%)
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%).
Mounjaro
Description
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%)
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.