The pursuit of weight loss is a common goal, and many individuals explore various avenues to achieve it. Prescription weight loss drugs can be a part of a comprehensive obesity treatment plan, but it's crucial to understand their ingredients, efficacy, and potential side effects. This article aims to provide a detailed overview of weight loss medications, their mechanisms of action, and the risks associated with their use.
Prescription Weight Loss Medications: An Overview
Prescription weight loss drugs are intended to be used alongside a low-calorie diet and a doctor-approved exercise plan for optimal results. It's essential to consult with a healthcare professional before starting any weight loss program to receive sound advice and understand that achieving permanent results requires time and discipline.
Several prescription weight loss drugs are available, each working through different mechanisms:
- Anorexiants: These drugs act in the brain to reduce appetite by affecting the parts of the brain that control feelings of fullness. They are used in conjunction with a regular diet and exercise plan.
- GLP-1 Receptor Agonists: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of medications used to treat type 2 diabetes mellitus and obesity. They work by increasing feelings of fullness and helping people maintain a more restrictive diet.
- Lipase Inhibitors: These medications block the enzyme that breaks down fats consumed through food, inhibiting the absorption of dietary fats. The undigested fat is then passed through the body.
- Appetite Suppressants: These drugs, often containing stimulants, work by suppressing appetite.
Specific Weight Loss Medications and Their Side Effects
Newer Prescription Drugs: Zepbound, Wegovy, and Saxenda
The latest prescription drugs, like Zepbound, Wegovy, and Saxenda, are approved for chronic (long-term) weight loss and come as subcutaneous (under the skin) injections. Up to a 20% weight loss or more has been seen with these newer treatments.
- Zepbound (tirzepatide): Tirzepatide was initially approved to treat type 2 diabetes. In 2023, it was approved for weight loss. As a GLP-1 and GIP receptor agonist, it increases feelings of fullness and helps people maintain a more restrictive diet. Common side effects include constipation, upset stomach, bloating, and diarrhea. Potential serious side effects also include stomach problems, kidney problems or failure, gallbladder problems, pancreatitis, or hypoglycemia, among others.
- Wegovy (semaglutide): Wegovy is also approved to help protect the heart. It is injected weekly. Gastrointestinal issues are the most common complaint among people who are just starting semaglutide. For this reason, many patients start at a lower dose and work up to their eventual dose.
- Saxenda (liraglutide): Saxenda is a glucagon-like peptide-1 (GLP-1) receptor agonist first approved in Dec. 2014. It is used in addition to diet and exercise for long-term weight management in adults who are obese (BMI ≥30 kg/m2) or overweight (BMI ≥27 kg/m2) with other weight-related medical issues. The Victoza brand of liraglutide contains the same active ingredient as Saxenda but is used to treat type 2 diabetes. Liraglutide is injected daily.
Other Prescription Medications
- Phentermine and Topiramate (Qsymia): Phentermine suppresses the appetite similar to an amphetamine stimulant. Topiramate is used a medication to control seizures. Some forms may cause stomach side effects like constipation, dry mouth, nausea or vomiting. The dose is taken once daily in the morning; avoid an evening dose as it may keep you awake. Side effects of taking phentermine-topiramate include abnormal sensations, dizziness, altered taste, insomnia, constipation, and dry mouth. Contraindications include uncontrolled hypertension and coronary artery disease, hyperthyroidism, glaucoma, and sensitivity to stimulants. Qsymia has restricted access because one of its active ingredients known as topiramate may cause severe birth defects in pregnant women. Do not use Qsymia if you are pregnant or planning a pregnancy.
- Bupropion and Naltrexone (Contrave): Bupropion is an antidepressant medicine, and naltrexone is usually given to block the effects of narcotics or alcohol in people with dependence. Contrave side effects can include constipation, dizziness, headache, trouble sleeping, and upset stomach. Do not use Contrave with other bupropion-containing products (such as Wellbutrin SR, Wellbutrin XL, Aplenzin) as it may increase the risk of severe side effects.
- Orlistat (Alli, Xenical): Xenical, the prescription form of orlistat, was first FDA-approved in 1999. Xenical was followed by the lower dose, over-the-counter (OTC) orlistat (alli) in 2007. Side effects of orlistat can be unpleasant: oily spotting, gas, stomach pain, fecal urgency or incontinence, soft stools, and the possibility of serious liver injury can occur.
Common and Serious Side Effects
Side effects of drugs used for weight loss may vary depending upon the type of drug you take and how the drug works. Weight loss drugs can be associated with important or serious side effects, and some may have the potential for dependence and abuse.
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- Common Side Effects:
- Gastrointestinal issues (nausea, vomiting, diarrhea, constipation, upset stomach, bloating, abdominal pain)
- Headache
- Dizziness
- Insomnia (difficulty sleeping)
- Dry mouth
- Altered taste
- Increased blood pressure and heart rate
- Nervousness
- Restlessness
- Oily spotting
- Gas
- Fecal urgency or incontinence
- Soft stools
- Serious Side Effects:
- Severe dehydration
- Kidney problems or failure
- Gallbladder problems
- Pancreatitis
- Hypoglycemia
- Liver injury
- Drug dependence, abuse, or withdrawal
- Thyroid tumors, including thyroid cancer
- Pulmonary aspiration (food or liquid getting into your lungs during procedures or surgery)
- Increased risk of heart attack and stroke
Considerations Regarding GLP-1RAs
GLP-1RAs are effective and acceptably safe treatments when used within their licensed indications. However, gastrointestinal side effects are more likely to occur at the start of treatment or after a recent increase in dose. The MHRA has received Yellow Card reports for individuals who have been hospitalized due to suspected adverse drug reactions with GLP-1RAs when used for weight loss. Severe dehydration following gastrointestinal adverse drug reactions has been reported, including for individuals who may not meet the prescribing criteria and may have used these medicines inappropriately for weight loss.
A paper published in late 2023 in JAMA quantified gastrointestinal adverse events ranging from nausea to pancreatitis. The JAMA study mentioned above compared GLP-1 agonists against naltrexone-bupropion. Researchers concluded that the use of the GLP-1 agonists was associated with an increased risk of pancreatitis, bowel obstruction, and gastroparesis.
"All-Natural" or "Herbal" Weight Loss Products
Many people consider buying an "all-natural" or "herbal" diet weight loss product, also called a weight loss dietary supplement, at the store or from the Internet. Chromium, Green Tea extract, Hoodia, and Guar Gum are some of the herbal dietary supplements available on the market today that claim to help with weight loss. These products may claim to "magically melt" fat away and seem like an easy fix to shed a few pounds.
It’s important to know that over-the-counter (OTC) dietary supplements are not reviewed or approved by the FDA. Federal regulators have warned that many of these marketed dietary supplements aren’t effective and may even cause serious side effects. The FDA does investigate herbal supplements if they appear to be causing harm. Many examples exist of recalled dietary supplements used for weight loss and other conditions.
Hidden Ingredients and Safety Concerns
The supplement market is very lightly regulated, and the weight-loss products you can buy online, via infomercial, or in nutrition stores could contain any number of hazardous substances. Even if the ingredients are approved for consumer use, they may contain chemical variations of banned or dangerous substances and dosages that are well above what has been deemed safe.
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FDA is unable to test and identify all products marketed as dietary supplements that have potentially harmful hidden ingredients. These products are typically promoted for sexual enhancement, weight loss, or body building and are often represented as being “all natural.”
Numerous public notifications have been issued by the FDA regarding weight loss products found to contain hidden drug ingredients.
Risks Associated with OTC Weight-Loss Supplements
- Damage to Your Heart: Many weight-loss drugs work by speeding up your body’s metabolism and heart rate in order to increase the amount of energy you burn.
- Increased Risk of Stroke: Many of these substances found in weight-loss supplements are stimulants, so they work by stimulating the heart to pump faster.
- Liver Dysfunction: Your liver has to deal with the ingredients and chemical byproducts when you take these things, and that can cause a build-up of enzymes that can be toxic.
Eligibility and Discontinuation of Medications
Eligibility for weight loss medications is typically based on body mass index (BMI). For semaglutide or liraglutide, a patient must must be an adult or child age 12 or more, with a BMI of 30 or greater or with a BMI of 27 or greater with comorbidities such as high blood pressure, diabetes, or high cholesterol. People who have a BMI of 30 or above do not need to have a chronic disease associated with their BMI, because obesity is considered a chronic disease. Requirements are similar for many other weight loss medications, including phentermine, naltrexone-bupropion, and orlistat, although not all are FDA-approved for use in children. The more recently approved tirzepatide is approved only for adults with a BMI of 30 or greater.
A 2023 analysis found that 68% of people taking semaglutide or liraglutide for weight loss stopped within a year. That population may have stopped for a variety of reasons, including side effects, cost coupled with lack of insurance coverage, or simply shortages of the medications. In the study above, 4.5% of users stopped the drugs due to side effects. Because stopping one of these medications comes with a high risk of weight regain, a person taking them should understand the risks.
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