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Zepbound™
Zepbound™ (tirzepatide) is a new injection prescription medication recently approved by FDA as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with obesity (BMI ≥ 30 kg/m2), or overweight (BMI ≥ 27 kg/m2) with at least one weight-related comorbid condition. Zepbound is the first and only FDA-approved obesity treatment that activates both GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1) hormone receptors. Zepbound activates receptors of hormones secreted from the intestine (GLP-1 and GIP) to reduce appetite and food intake. Common side effects may include nausea, diarrhea, vomiting, constipation, abdominal discomfort, injection site reactions, fatigue, and allergic reactions. Zepbound contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. We strongly advise to check the indication and safety summary of this new medicine here https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-zepboundtm-tirzepatide-chronic-weight
Phentermine, Tenuate (Diethylpropion)
These medications have the benefit of nearly 60 years of clinical experience (Phentermine was approved in 1959), are low cost, and are very effective. We generally use them first-line for these reasons. They work in an area of the brain that controls hunger and discourages energy storage. They have a mild stimulant effect (not too unlike caffeine), so unless directed otherwise, take first thing in the morning. Side effects may include dry mouth, constipation, elevation in heart rate or blood pressure, agitation, and insomnia. Most side effects are minor and resolve as your body gets used to the new medication; however, if you experience severe side effects, please discontinue your medication immediately and let us know.
We typically avoid this class of medications in people with pre-existing heart disease or uncontrolled high blood pressure. Although not FDA-approved for chronic use due to lack of clinical trials it is accepted as appropriate therapy by obesity medicine specialists for chronic use for appropriate individuals.
We recommend avoiding other stimulants (caffeine, Sudafed) while taking appetite suppressant medication. If you are planning to have surgery it is recommended to hold these medications for at least 7 days prior to anesthesia.
Contrave®
Contrave is a combination of 2 medications – bupropion and naltrexone. It works in two separate areas of the brain to control hunger and reduce cravings. Side effects may include suicidal thoughts and other neuro-psychiatric reactions, nausea, vomiting, headache, and insomnia. Most side effects are mild and go away quickly. It can’t be used if you are on narcotic pain medications, have history of seizure, or risk factors for seizure like anorexia, bulimia, or heavy alcohol use. It is FDA approved for chronic use for appropriate individuals. If the branded combination drug is not approved we will use the generic forms of the two medications as off label treatment.
Qsymia®
Qsymia is a combination of 2 medications – phentermine and topiramate. The phentermine is at lower dose than what we typically use with the older forms of phentermine, and the topiramate is time-released. This gives very good appetite control – the phentermine through the first half of the day, then the topiramate during the second half of the day.
Side effects can include numbness or tingling in the hands, arms, feet, or face (paraesthesia); dizziness; changes in the way foods taste or loss of taste (dysgeusia); trouble sleeping (insomnia); constipation; and dry mouth. This drug can cause birth defects if a woman becomes pregnant while taking it; therefore, if you are of childbearing potential, special counseling is needed to determine if this is a safe choice. It is approved for chronic use for appropriate individuals. If the branded combination drug is not approved we will use the generic forms of the two medications as off label treatment.
Saxenda®
Saxenda is a once daily injectable medication approved for the treatment of obesity. It is a synthetic analog of a hormone your gut produces in response to meals that tells your brain you shouldn’t be hungry any more. The main side effect is nausea, but this generally goes away as your body gets used to the medication.
The drug can’t be used if you have a history of or are at risk for medullary thyroid carcinoma. The same molecule, liraglutide, has been available for the treatment of type two diabetes since 2010 (brand name Victoza); however, the dose used for weight control is significantly higher. It is approved for chronic use for appropriate individuals. If you are interested in Saxenda, contact your health insurance carrier to see if you have coverage. Or, check www.SaxendaCoverage.com.
Wegovy®
Wegovy is a once weekly injectable medication approved for the treatment of obesity. It is a synthetic analog of a hormone your gut produces in response to meals that tells your brain you shouldn’t be hungry any more. The main side effect is nausea, but this generally goes away as your body gets used to the medication.
The drug can’t be used if you have a history of or are at risk for medullary thyroid carcinoma. The same molecule,semaglutide, has been available for the treatment of type two diabetes, however, the dose used for weight control is significantly higher. It is approved for chronic use for appropriate individuals.
Metformin
Metformin is a daily tablet medication that can be helpful in the treatment of obesity. This medication has been available for the treatment of type two diabetes, however, there is evidence of weight control benefits at higher doses of 1500-2000 mg. The main side effects include nausea, abdominal cramping, and loose stools.
Mounjaro®
Mounjaro is a once weekly injectable medication approved for the treatment of Diabetes. It is a synthetic analog of two hormones your gut produces in response to meals to control your blood sugars but these hormones also tell your brain you shouldn’t be hungry anymore.
The main side effect is nausea, but this generally goes away as your body gets used to the medication. The drug can’t be used if you have a history of or are at risk for medullary thyroid carcinoma. Although this drug is very effective for weight loss it is not yet approved for use for this indication.
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