Which Prescription Drugs Are Approved for Weight Loss?

Obesity is a complex health issue that affects millions of people worldwide. While lifestyle changes such as diet and exercise are crucial in managing obesity, for many individuals, these steps alone may not be sufficient. In such cases, prescription medications can play a vital role. These drugs work through various mechanisms to help control appetite, enhance feelings of fullness, or limit the absorption of dietary fats.

Each medication offers a unique approach to weight loss, targeting different aspects of the body's metabolism and appetite regulation. However, it's important to understand that these medications are not a standalone solution. They are most effective when used in conjunction with lifestyle modifications.

Prescription weight loss drugs are generally prescribed for individuals who have a significant level of obesity, typically measured by body mass index (BMI), and often for those who have obesity-related health conditions. Understanding the potential side effects and costs associated with these medications is also important for choosing the right medication.

Genetic Obesity

In some cases, obesity is caused by genetic factors, and typical weight loss methods might not work. This type of obesity needs a different treatment approach.

Setmelanotide (Imcivree) is a prominent medication approved for treating obesity caused by genetic conditions. It's particularly effective for individuals with deficiencies in genes such as POMC, PCSK1, or LEPR. Setmelanotide works by targeting pathways in the brain that regulate hunger and satiety, helping to control appetite and food intake.

Contrave (bupropion-naltrexone)

Mechanism

Contrave combines two active ingredients, bupropion and naltrexone. Bupropion is an antidepressant that also reduces appetite, while naltrexone is usually used to treat addiction and helps reduce the pleasure associated with eating. Together, they work on the brain's appetite and reward systems to help you feel less hungry and find food less rewarding, ultimately leading to decreased food intake.

Side Effects

Common side effects include nausea, constipation, headaches, dizziness, vomiting, and dry mouth. These effects can vary in intensity and may decrease over time as the body adjusts to the medication.

Usage and Cost

Contrave is taken orally, typically as two tablets twice daily. The cost averages around $750 per month, which can vary based on location and insurance coverage.

Saxenda (liraglutide)

Mechanism

Saxenda is a GLP-1 (glucagon-like peptide-1) receptor agonist. GLP-1 is a hormone that regulates appetite. By mimicking and enhancing GLP-1's effects, Saxenda increases feelings of fullness, delays stomach emptying, and reduces hunger, leading to a lower calorie intake.

Side Effects

Saxenda's side effects include nausea, low blood sugar (especially in people with diabetes), diarrhea, constipation, vomiting, reduced appetite, and heartburn. Monitoring by a healthcare provider is important, especially at the beginning of the treatment.

Usage and Cost

This medication is administered via injection under the skin, typically once per day. The average cost is about $1,600 per month, though this can vary.

Xenical (orlistat)

Mechanism

Xenical, or orlistat, works directly in the digestive system. It inhibits pancreatic lipases, enzymes responsible for breaking down fats in the diet. By preventing fat breakdown, it reduces the amount of fat absorbed by the body, leading to a calorie deficit and weight loss.

Side Effects

Side effects are mainly gastrointestinal and include oily rectal spotting, gas with bowel movements, urgent bowel movements, oily stools, increased frequency of bowel movements, and oily leakage. These effects are often worse when consuming a high-fat diet and tend to improve with long-term use.

Usage and Cost

Xenical is an oral medication taken three times daily with fat-containing meals. The cost for a month's supply is around $750, which may vary depending on pharmacy and insurance coverage.

Qsymia (phentermine-topiramate)

Mechanism

Qsymia combines phentermine and topiramate, each targeting weight loss differently. Phentermine is an appetite suppressant, affecting the central nervous system to reduce hunger. Topiramate, originally used for seizures and migraine prevention, contributes to a feeling of fullness and may also influence taste sensation, leading to reduced calorie intake.

Side Effects

Common side effects include tingling in hands and feet, dizziness, altered taste, difficulty sleeping, constipation, and dry mouth. These effects can vary and may lessen over time.

Usage and Cost

Qsymia is taken orally, usually once a day in the morning to avoid insomnia. The average cost is about $250 per month, though this can vary based on dosage and insurance coverage.

Wegovy (semaglutide)

Mechanism

Wegovy, like Saxenda, is a GLP-1 receptor agonist. It imitates the GLP-1 hormone, increasing feelings of fullness, slowing down gastric emptying, and reducing appetite, leading to decreased food intake and weight loss. Wegovy has a longer duration of action compared to Saxenda, requiring less frequent dosing.

Side Effects

The side effects of Wegovy can include nausea, diarrhea, vomiting, constipation, abdominal pain, and tiredness. These may be more pronounced at the start of treatment and tend to decrease over time.

Usage and Cost

Wegovy is an injectable medication, administered once a week. The cost is around $1,600 per month, which can vary depending on insurance and pharmacy.

Imcivree (Setmelanotide)

Mechanism

Imcivree specifically targets MC4 receptors in the brain. These receptors play a crucial role in regulating hunger, satiety, and energy expenditure. Imcivree is used for genetic obesity cases where mutations in certain genes disrupt the MC4 pathway, leading to excessive hunger and weight gain. By activating these receptors, Imcivree helps to normalize hunger cues and reduce appetite.

Side Effects

Common side effects include changes in skin color, nausea, headaches, diarrhea, abdominal and back pain. The severity of these side effects can vary among individuals.

Usage and Cost

This medication is administered through daily injections under the skin. It is the most expensive option, costing approximately $20,000 per month, reflecting its specialized nature and the complexity of the conditions it treats.

These medications represent advanced options in the treatment of obesity, each with a unique approach and mechanism of action. The choice of treatment should be based on individual health profiles, the specific causes of obesity, and should always be made in consultation with healthcare professionals.

Cost of Saxenda

Cost is often a limiting factor for the use of weight loss medications such as Saxenda. At a typical pharmacy, the cost of a single month supply of Saxenda is about $1,600.

Prices mentioned in this article are based on average retail price at major box chain pharmacy in the U.S. as of Decmber, 2023.