Drugs
Naltrexone/
bupropion
(8mg/90mg)
MOA/Indication
Opioid receptor antagonist
DA/NE reuptake inhibitor
Bupropion – DA/NE stimuli
w/o inhibition of MAO or
5HT
Inhibit DA or NE decreases
reward pathway
Dosing
1st week: 1 QAM
2nd week: 1 QAM, 1 QPM
3rd week: 2 QAM, 1 QPM
4th week and on: 2 QAM, 2
QPM
Stop if < 5% loss at 12
weeks
Naltrexone – blocks an
opioid pathway that may
slow weight loss
Belviq
(lorcaserin)
Selective 5HT2C receptor
agonist – promote satiety
and decrease food intake
10 mg BID
DC at week 12 if 5% weight
loss not achieved
Same indication as Qsymia
Max 20 mg/day
SE
SE: N&V, HA, insomnia, dizziness
Warning: BP/HR increase, seizure
increase, glaucoma, hepatotoxity
CI: seizure disorder, uncontrolled
HTN, chronic opioid use, MAOIs,
pregnancy, or hx of suicide
SE: dizziness, confusion, somnolence
CI: use with Thioridazine (increases
its levels)
DC if 5% weight loss not
achieved after 12 weeks on
3.75/23
No MOA given?
Adjunct to reduced calorie
diet and increased physical
activity for BMI > 30 or > 27
with 1 weight related
comorbidity (HTN, T2DM,
dyslipidemia)
1 tab QD for 14 days, then
increase 2 tab.
Increase dose if 3% weight
loss is not achieved over 12
weeks on 2 tabs.
DC if 5% weight loss not
achieved after 12 weeks on
max dose 15/92 (3 tabs) –
DC dose gradually to
prevent seizure
Counseling
Black box for suicidal behavior.
No safety in < 18 yo
Qsymia
(phentermine
and
topiramate)
DI
SE: tingling hands/feet, dizziness,
altered taste, insomnia,
constipation, dry mouth
Increased risk of serotonin
syndrome (HTN, tachycardia,
hyperthermia, myoclonus,
mental status change):
 Dextromethorphan
 Desipramine
 SSRIs
 Amitriptyline
 Imipramine
 Clomipramine
 Paroxetine
Monitor: blood glucose, CBC,
prolactin, new or worsening
depression/suicidal thoughts or
behavior
Increases levels of these drugs:
 Atomoxetine
 Metoprolol
 Propafenone
Oral BC: altered exposure 
irregular bleeding but not
increased risk of pregnancy.
STOP and immediately call Dr if
erection > 4 hrs
Avoid activities requiring
mental alertness or
coordination until you know
how it affects you.
Sx of serotonin syndrome
Take in morning. Avoid evening
dose to prevent insomnia
Do not DC BC if spotting occurs.
CI: do not exceed 7.5/46 with
mod/severe renal impairment or
moderate hepatic impaired
CNS depressants including
alcohol: potentiate CNS effects
Non K sparing Diuretics: may
potentiate hypokalemia
Avoid use of alcohol together
Measure K before/during tx
No safety in < 18 yo
Saxenda
(liraglutide)
GLP1 receptor agonist
Centrally active to increase
satiety and decrease gastric
emptying
Indiations: same as Qysmia
Xenical
(orlistat)
OTC = Alli
Gastrointestinal lipase
inhibitor:
Lipases essential for LCT
absorption
Inhibition results in
decreased FFA formation
from TG.
Lowers dietary fat
absorption
Up to 30% decrease with
360mg daily
QD SC. Start 0.6 mg and
titrate up weekly by 0.6 as
tolerated. Max 3mg/day
N&V, diarrhea, HA, hypoglycemia in
non DM
Tolerate out over time
DC if 5% weight loss not
achieved after 12 weeks on
Boxed warning: thyroid c cell tumors
in rodents
HLD: 120 mg TID with meals
Obesity: same
OTC: 60 mg TID during or
w/in 1 hr of each fat
containing meal
Kids 12-16: 120 mg TID
during or w/in 1 hr of each
fat containing meal
Must take with food that
contains fat to have effect
Warning: acute pancreatitis, acute
gall bladder dx, serious
hypoglycemia if used with insulin, HR
increase, caution in renal impaired.
Hypersensitivity rxns can occur.
Monitor for depression/suicide but
lower compared to other agents
Soft stool, ab pain/colic, flatulence,
fecal urgency, incontinence
(most common first 1-2 mo)
Malabsorption of fat soluble
vitamins if on > 6 weeks
Cyclosporine – decreases
cyclosporine concentrations
Eat balanced diet containing
~30% calories from fat (too
much fat will increase GI SE)
Encourage MVI containing fat
soluble vitamins at least 2 hrs
before of after drug