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The Doctor’s Tool Kit: Pharmacotherapy for the Patient with Obesity

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The Clinician’s Guide to the Treatment of Obesity

Part of the book series: Endocrine Updates ((ENDO))

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Abstract

This chapter examines the use of drugs as adjuncts to lifestyle in the treatment of the patient who is overweight or obese. There are two groups of approved drugs that can be used in this setting. The first are the four drugs currently approved for long-term treatment of obesity and a few others that can be used for short-term treatment. Orlistat partially blocks intestinal digestion of fat and produces weight loss of 5–8 kg. Its major limitations are associated gastrointestinal symptoms. Lorcaserin is a serotonin agonist that produces weight loss of 4–7 kg. It has few side effects. The combination of phentermine and topiramate in an extended release formulation produces weight loss of 8–10 kg but must be used only after showing a woman of child-bearing potential is not pregnant. The combination of bupropion 360 mg and naltrexone 60 mg in sustained release formulation is intermediate in weight loss efficacy compared to lorcaserin or phentermine/topiramate ER, but requires dose escalation over 3 weeks because of nausea and vomiting. Additionally, liraglutide has been under Food and Drug Administration (FDA) consideration for approval, and may be available in 2015. The short-term drugs are sympathomimetics with phentermine being most widely used. In obese patients being treated for type 2 diabetes, depression, convulsive disorders, migraine headaches, or psychiatric illnesses, it is important to select drugs, where possible, that, as part of their mechanism of action, reduce weight rather than drugs which increase weight.

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Author information

Authors and Affiliations

  1. Pennington Biomedical Research Center, 6400 Perkins Road, 70808, Baton Rouge, LA, USA

    George A. Bray MD, MACP, MACE

  2. Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, 70808, Baton Rouge, LA, USA

    Donna H. Ryan MD, FACP

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  1. George A. Bray MD, MACP, MACE
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  2. Donna H. Ryan MD, FACP
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Correspondence to George A. Bray MD, MACP, MACE .

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Editors and Affiliations

  1. Assistant Professor of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Adrienne Youdim

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Bray, G., Ryan, D. (2015). The Doctor’s Tool Kit: Pharmacotherapy for the Patient with Obesity. In: Youdim, A. (eds) The Clinician’s Guide to the Treatment of Obesity. Endocrine Updates. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2146-1_6

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  • DOI: https://doi.org/10.1007/978-1-4939-2146-1_6

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