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In this episode I talk with Ted Kyle, RPh, MBA about obesity medications. Ted is a pharmacist who has now moved on to his second career as the founder of ConscienHealth which “exists to help experts and organizations work for sound approaches to health and obesity.” Ted blogs daily and is very knowledgeable on many obesity-related topics including the newest obesity medications available.
In this episode we discuss:
- Ted’s background as a pharmacist and his journey to his second career as the founder of ConsceinHealth
- Why did ten years pass between the last FDA approved obesity medication and the next?
- Is there a role for obesity medications after bariatric surgery?
- The 4 new medications: Lorcaserin (Belviq), Phentermine-Topiramate (Qsymia), Liraglutide (Saxenda), Buproprion-Natrexone (Contrave)
Lorcaserin (Belviq)
- It works as a 5HT2C receptor agonist which helps increase satiety (reduce hunger).
- Indicated for people who have a BMI >30 or BMI >27 with weight-related co-morbid conditions.
- The dose is 10mg twice daily.
- It is approved for long-term use. However, the medication should be discontinued if the person has not lost 5% weight after 12 weeks of treatment.
- Contraindications: Pregnancy
- Warnings: Co-administration with other SSRI medications (Paxil, Prozac, Celexa, Lexapro, Zoloft) and Antidopamine medications. See package insert and talk with your prescriber for more details.
- Potential Side Effects: Headache, dizziness, nausea, constipation, fatigue, dry mouth.
Phentermine/Topiramate (Qsymia)
- How they work: Phentermine works on the central nervous system to reduce appetite and possibly increase thermogenic burning of calories. Topiramate works in the central nervous system. The mechanism is not clear but it probably works to reduce appetite and increase satiety.
- Indicated for people who have a BMI >30 or BMI >27 with weight-related co-morbid conditions.
- It is approved for long-term use however if there is less than 5% weight loss after 12 weeks on the full dose, the medication should be stopped by taking one pill every other day for one week then stop.
- The dose starts low and increases carefully. The starting dose is 3.75mg/23mg for two weeks, then 7.5mg/46mg. If after 12 weeks there is not 3% weight loss then either discontinue or advance to the full dose 15mg/92mg.
- Contraindication: Pregnancy. Glaucoma.
- Potential Side Effect: Birth defects, increased heart rate, suicidal thoughts, sleep disorders. See package insert and talk with your prescriber for more details.
Liraglutide (Saxenda)
- This medication is currently available as a type 2 diabetes medication known as Victoza. For type 2 diabetes treatment it has been available in Europe since 2009 and in the U.S. Since 2010. However, Novo-Nordisk, the maker of liraglutide, are seeking FDA approval of this medication specifically as an obesity medication based on the knowledge that one of the desirable side effects of liraglutide is weight loss. When approved for obesity treatment liraglutide will be marketed as Saxenda and will be dosed differently. Although as of November 1st, 2014 Saxenda is not yet been approved, it is anticipated to be approved this year for a 2015 launch.
- It works through both the central nervous system and the gastrointestinal system to reduce hunger and control glucose levels.
- Indication: Not yet available.
- Potential dosing (once it is approved): thought to be 3mg subcutaneous injection via an injection pen.
- Potential side effects: Rare side effect of pancreatitis, which is a “class label.” Class label means that all the medications in a group have the same potential side effect.
- Contraindications and cautions are not yet stated for Saxenda but the listed contraindications for Vicotza include a history of pancreatitis.
- Potential Side Effects: See package insert and talk with your prescriber when this medication is available.
Bupropion/Naltrexone (Contrave)
- How they work: Bupropion (Wellbutrin) is an antidepressant medication that has also been shown to reduce appetite. Naltrexone is an anti-addiction medication that blocks one of the “reward” receptors in the central nervous system that has been shown to be connected with addiction. Together these medications work to reduce hunger and cravings for food.
- Indicated for people who have a BMI >30 or BMI >27 with weight-related co-morbid conditions.
- The dose is 8mg/90mg taken with food. The directions are to start with 1 pill in the morning for 7 days, then increase to 1 pill twice daily for 7 days, then if needed the dose can be increased to 2 pills in the morning and 1 pill at night for 7 days then 2 pills twice daily and onward (again if needed). Response to therapy should be evaluated after 12 weeks at the maintenance dose. If the person has not lost at least 5% of their starting weight, the medication should be discontinued.
- Contraindications: Pregnancy, uncontrolled high blood pressure, seizure disorders, bulimia, anorexia, chronic use of opiods, MAOI medications, see package insert and talk with your prescriber for more information.
- Potential Side Effects: There is a warning for suicidal thoughts and behaviors. The most common side effects are high blood pressure, dizziness, nausea, constipation, headache, dry mouth, see package insert and talk with your prescriber for more information.
Important Links
Ted Kyle Website
Ted Kyle Facebook
Ted Kyle Twitter
Belviq Website
Qsymia Website
Contrave Website
Obesity Action Coalition
Dr John Morton article Obesity Medications and Bariatric Surgery can they work together?
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On of my favorite quotes: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ― Maya Angelou
Kindly,
Reeger
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