Prescription Weight Loss Drugs Review
Updated: Apr 11
Have you ever been curious about weight loss drugs? Well I’m here to share all of your options with you. Along with diet and exercise, prescription weight loss drugs can help some people lose weight. These medications can generally help people lose 5-10% or more of their body weight. This might not sound like much, but this weight reduction is significant enough to improve overall health.
Prescription weight loss drugs are generally indicated for people with a body mass index, or BMII, over 30, or a BMI over 27 when there are existing weight-related medicals problems. They are not appropriate for women who are pregnant, trying to get pregnant, or are breastfeeding.
Getting your health insurance company to cover these drugs can be challenging. From my experience, I would say the more than half of insurance companies do not pay for any weight loss drug. If your provider feels you would benefit from a weight loss drug, you can contact your insurance provider and inquire about coverage. If you’re willing to pay out of pocket, some of these drugs are in the realm of being affordable, at $150 per month or less. With savings cards and other types of discounts, less than $50 a month may be possible. I know many patients that have spent more than this on weight loss supplements, over-the-counter products and even laser fat removal.
Let’s take a look at all of the weight loss drugs available with a prescription:
Phentermine (Adipex-P, Suprenza)
Remember all the scary stuff you heard about Fen-Phen back in the 1990’s? Well phentermine is the “Phen” in Fen-Phen. The other fen part though, fenfluramine, was the drug that was taken off the market in 1997 after patients were developing heart valve disease. Phentermine, which is a stimulant and appetite suppressant, has not been linked to heart value problems, but it still should be used with caution. It is only available for short-term use only as there is a risk of abuse and dependence. It should not be used for more than 12 weeks. This is the most popular and least expensive medication option.
Phentermine is approved for use in people over the age of 16. Most other weight loss medications are approved for 18 years and older.
Side effects can include raising blood pressure, heart palpitations, restlessness, dizziness, tremor, insomnia, shortness of breath and chest pain. Less serious side effects include dry mouth, diarrhea, constipation and vomiting. You should not take phentermine if you have a history of heart disease, stroke, congestive heart failure, uncontrolled high blood pressure or a history of drug abuse. Many providers require a monthly blood pressure check while on this medication.
Saxenda is an injectable medication which is actually just a higher dose of a Victoza, a medication for type 2 diabetes. It mimics an intestinal hormone that tells your brain when your stomach is full. You inject it in your stomach, upper arm or thigh once daily. You will start on a small dose and increase the dose each week for several weeks. This is done to minimize gastrointestinal side effects.
In December 2020, the drug was approved for use in adolescents ages 12-17 years old with a body weight of 60kg (132 lbs) or more. This makes it one of the few drugs available for use in adolescents.
This drug class is contraindicated for people that have a very specific type of endocrine condition called MEN 2 or people with a personal or family history of medullary thyroid carcinoma. Side effects include nausea, vomiting, diarrhea, and constipation. Serious side effects can include thyroid tumors, raised heart rate, pancreatitis, gallbladder disease, kidney problems and suicidal thoughts. For people with diabetes on insulin and/or sulfonylureas, it can cause hypoglycemia and other medications may need to be adjusted. If you don’t lose 4% after 16 weeks, you should discontinue this drug as it’s unlikely to work for you.
Wegovy is similar to Saxenda as is is a higher dose of the injectable medication Ozempic, which is a diabetes drug in the same class at Saxenda. You will start on a small dose and increase the amount every four weeks until you reach the full dose of 2.4mg.
Despite Wegovy being a similar drug as Saxenda, it has been called a “game changer” in the healthcare community as it has shown to have the greatest amount of weight loss compared to any other weight loss drug on the market. Most of the other drugs cause a 5-10% reduction in bodyweight, while in one study people on Wegovy lost an average of 15% of their bodyweight.
This drug class is contraindicated for people that have a very specific type of endocrine condition called MEN 2 or people with a personal or family history of medullary thyroid carcinoma. Side effects include nausea, vomiting, diarrhea, and constipation. Serious side effects can include thyroid tumors, raised heart rate, pancreatitis, gallbladder disease, kidney problems and suicidal thoughts. For people with diabetes on insulin and/or sulfonylureas, it can cause hypoglycemia and other medications may need to be adjusted. For people with type 2 diabetes, it can increase the risk of diabetic retinopathy complications.
This medication consists of two different drugs, naltrexone and bupropion. Naltrexone is approved to treat alcohol and opioid dependence. Bupropion is approved to treat depression, seasonal affective disorder and to help people quit smoking. Together they can help with weight loss.
Common side effects include nausea, constipation, headache, vomiting, dizziness, insomnia, dry mouth and diarrhea. There is a warning about the increased risk of suicidal thoughts and behaviors associated with buproprion. Contrave can cause seizures so they should not be used by people with a history of that. Also, this drug can increase your blood pressure and heart rate so it’s not appropriate for people with uncontrolled hypertension. If you don’t lose 5% of your body weight after 12 weeks, again, you should discontinue this medication as it’s unlikely to work for you.
This medication is a combination of phentermine and topiramate which is a seizure/migraine medication. Phentermine (see above) is an appetite suppressant, while topiramate causes weight loss in a combination of ways; it helps you feel full, making foods taste less appealing and helps you burn more calories. Qysmia is approved for long-term use as it contains a low-dose of phentermine.
Side effects include tingling in hands and feet, dizziness, altered sense of taste, insomnia, constipation and dry mouth. Serious side effects can include birth defects, increased heart rate, suicidal thoughts and eye problems. You shouldn’t take this medication if you have glaucoma, hyperthyroidism, heart disease, or stroke. If you don’t lose 3% body weight after 12 weeks, you should gradually decrease the dose over time, and then discontinue it as it’s unlikely to work for you.
Orlistat (Xenical, Alli)
This medication works by stopping your body from absorbing about a third of the fat you eat. Xenical is the prescription dose while Alli is available over the counter, though Alli is only half the strength. It is the only weight loss medication available for the use in children as it is approved for people ages 12 and over. A multivitamin should be taken while on orlistat as this medication affects the absorption of vitamins A, D, E and K.
Orlistat is FDA approved for the use in people 12 years and older. This makes it one of the few weight loss mediations approved for adolescents.
Side effects can include abdominal cramping, passing gas, leaking oily stool, having more bowel movements, and not being able to control bowel movements. Side effects are generally mild and temporary, but may get worse if you eat high-fat foods.
These drugs are stimulants and suppress appetite, just like phentermine. They are only available for short-term use only, as there is a risk of abuse and dependence.
Side effects can include raising blood pressure, heart palpitations, restlessness, dizziness, tremor, insomnia, shortness of breath and chest pain. Less serious side effects include dry mouth, diarrhea, constipation and vomiting. You should not take diethylpropion if you have a history of heart disease, stroke, congestive heart failure, uncontrolled high blood pressure or a history of drug abuse.
Plenity is quite different than the other available weight loss medications. This pill is actually not considered a medication, but rather a “medical device”. Because of this, it cannot be picked up at your regular pharmacy. Your regular provider can prescribe it, or you can go to plenity.com to have an online visit with a healthcare professional to have it prescribed.
Three capsules are taken with 16oz water 20 minutes before lunch and dinner. The Plenity particles inside the capsule grow and expand to take up space in your stomach so you feel full. It is then excreted through your gastrointestinal tract just like food.
Plenity is for people with a BMI of 25-40. Side effects can include diarrhea, distended abdomen, infrequent bowel movements, flatulence and abdominal pain.
So, as you can see, none of these drugs are going to provide any miracles, but they can definitely help. Diet and exercise are your key to weight loss, but medications, for some people, can be a helpful addition. Medications can help a helpful tool in your tool belt, but shouldn't be the only one you're using!