The pharmacological treatment of obesity is a rapidly evolving field, demanding continuous updates for healthcare providers. With a growing selection of weight loss medications available, patients may ask what the strongest or most effective weight loss prescription medication is, and which one is best for them. The answer is complicated, and newer is not always better. Determining whether someone is a candidate for weight loss medications begins with BMI. For each individual case, the doctor and patient should discuss the patient’s current health issues, other medications, and family medical history. While some weight loss medications are FDA-approved only for adults, some-including semaglutide and liraglutide-are approved for children 12 and older with a BMI >/= 95th percentile. It can be easy to overlook first-generation AOMs, but these may be appropriate for some patients, especially when cost is a factor.
This article delves into the role of Puralin, alongside an overview of current medical approaches to weight loss, including prescription medications and lifestyle interventions.
Understanding Puralin: Composition and Potential Effects
Puralin, also known as Thiram, is a dithiocarbamate chemical used in the rubber processing industry and as a fungicide. The National Library of Medicine's Medical Subject Headings online file (MeSH, 1999) indicates it has a wide spectrum of antibacterial activity and is effective against several dermatophytes. Serum does not appear to suppress its activity. It is marketed only as a component of plastic film that is sprayed onto dry surgical wounds for the purpose of preventing post operative infections, specifically, a film containing 0.5% thiram.
The chemical is also known under a variety of other names, including: Tetramethylthiuram Disulfide, Rezifilm, Tmtd, Pomarsol, Thirame, Arasan, Fernasan, Nobecutan, Thioscabin, Thirasan, Aapirol, Tersan, Tetrathiuram Disulfide, Tetramethylthiuram, Falitiram, Formalsol, Hexathir, Kregasan, Mercuram, Normersan, Sadoplon, Spotrete, Tetrasipton, Thillate, Thiramad, Aatiram, Atiram, Fermide, Fernide, Hermal, Pomasol, Thiosan, Thiotox, Thiulin, Thiulix, Heryl, Pomarsol Forte, Methyl Tuads, Polyram Ultra, Accelerator T, Methyl Thiram, Fernasan A, Tetramethylthiuram Disulphide, Nocceler Tt, Arasan-m, Bis(dimethylthiocarbamoyl) Disulfide, Thiram B, Arasan-sf, Cyuram Ds, Ekagom Tb, Hermat Tmt, Tetramethylenethiuram Disulfide, Accel Tmt, Accelerator Thiuram, Aceto Tetd, Radothiram, Royal Tmtd, Tetramethyl-thiram Disulfid, Fernacol, Sadoplon 75, Tetramethylthiuram Bisulfide, Tetrapom, Thioknock, Thirampa, Thiramum, Anles, Arasan-sf-x, Aules, Thimer, Panoram 75, Tetramethylthiouram Disulfide, Tetramethylthiurane Disulfide, Arasan 70, Arasan 75, Tersan 75, Thiram 75, Thiram 80, Spotrete-f, Tmtds, Arasan 70-s Red, Tetramethylthioperoxydicarbonic Diamide, Methylthiuram Disulfide, N,n-tetramethylthiuram Disulfide, Metiurac, Micropearls, Nomersan, Thianosan, Cunitex, Delsan, Thimar, Teramethylthiuram Disulfide, Tersantetramethyldiurane Sulfide, Pol-thiuram, Arasan 42-s, Tetramethylthiurum Disulfide, Disulfure De Tetramethylthiourame, Tetrathiuram Disulphide, Sranan-sf-x, Hy-vic, Sq 1489, Chipco Thiram 75, Bis(dimethyl-thiocarbamoyl)-disulfid, Orac Tmtd, Tetramethylthioramdisulfide, Tetramethyldiurane Sulphite, Thiotox (fungicide), Disulfide, Bis(dimethylthiocarbamoyl), Bis((dimethylamino)carbonothioyl) Disulfide, Fermide 850, Tetramethyl Thiuramdisulfide, Tetramethylthiocarbamoyldisulphide, Thiuramyl, Thylate, Methyl Thiuramdisulfide, Bis(dimethylthiocarbamyl) Disulfide, Tetramethyl Thiurane Disulfide, Bis(dimethyl Thiocarbamoyl)disulfide, Thirame [inn-french], Thiramum [inn-latin], Thiuram D, Disolfuro Di Tetrametiltiourame, Tetramethyl Thiurane Disulphide, Tetramethylenethiuram Disulphide, N,n'-(dithiodicarbonothioyl)bis(n-methylmethanamine), Rcra Waste Number U244, Flo Pro T Seed Protectant, Tetramethylthiuram Bisulphide, Tetramethylthiuran Disulphide, Tetramethylthiurum Disulphide, Nsc-1771, Tetramethyl Thiuram Disulfide, Alpha,alpha'-dithiobis(dimethylthio)formamide, Thiotex, Thiurad, Tirampa, Tiuramyl, Trametan, Tridipam, Tripomol, Tyradin, Tuads, Tutan, Vulkacit Mtic, N,n,n',n'-tetramethylthiuram Disulfide, N,n-tetramethylthiuram Disulphide, Vulkacit Thiuram, Thioperoxydicarbonic Diamide, Tetramethyl-, Thiuram M, Vulkacit Th, Tetramethylthioramdisulfide [dutch], Vulcafor Tmt, Vulcafor Tmtd, Bis((dimethylamino)carbonothioyl) Disulphide, Fmc 2070158, Bis(dimethylthiocarbamoyl) Disulphide, Tetramethyl-thiram Disulfid [german], Formamide, 1,1'-dithiobis(n,n-dimethylthio-, Dimethylcarbamothioylsulfanyl N,n-dimethylcarbamodithioate, Zaprawa Nasienna T, [me2nc(s)s]2, Vancida Tm-95, Disulfuro Di Tetrametiltiourame, Arasan 42s, Tuex, Disolfuro Di Tetrametiltiourame [italian], Disulfuro Di Tetrametiltiourame [italian], Disulfure De Tetramethylthiourame [french], Nsc1771, Bis(dimethyl-thiocarbamoyl)-disulfid [german], Vuagt-i-4, Nsc-49512, Thioperoxydicarbonic Diamide ([(h2n)c(s)]2s2), Tetramethyl-, Nsc-622696, [disulfanediylbis(carbonothioylnitrilo)]tetramethane, Thiuram M Rubber Accelerator, Mls000069752, Mls002702972, 0d771is0fh, Chebi:9495, Thiuram Disulfide, Tetramethyl-, Dtxsid5021332, Thiuram-m, Thioperoxydicarbonic Diamide (((h2n)c(s))2s2), Tetramethyl-, Nsc49512, Ccg-35460, Nsc-59637, Nsc622696, Tntd, Sq-1489, Ncgc00091563-01, Smr000059023, Thioperoxydicarbonic Diamide ((h2n)c(s))2s2, Tetramethyl-, [dithiobis(carbonothioylnitrilo)]tetramethane, Dsstoxcid1332, Dsstoxrid76087, .alpha.,.alpha.'-dithiobis(dimethylthio)formamide, Dsstoxgsid21332, Caswell No. 856, Granuflo, Thiuramin, N,n',n'-tetramethylthiuram Disulfide, Thioperoxydicarbonic Diamide (((h2n)c(s))2s2), N,n,n',n'-tetramethyl-, Cas-137-26-8, Formamide,1'-dithiobis(n,n-dimethylthio-, Bis[(dimethylamino)carbonothioyl] Disulfide, Attack [antifungal], Thiram [iso], Nsc59637, Ccris 1282, Hsdb 863, Ent 9872, Wln: 1n1 & Yus & Ssyus & N1 & 1, Nsc 1771, Einecs 205-286-2, Nsc 49512, Nsc 59637, Rcra Waste No. U244.
Absorption, Distribution, Metabolism, and Excretion
Tetramethylthiuramdisulfide appears to be readily absorbed through the intestinal tract and the lungs and is quickly and widely distributed throughout the body. In 2 days following its ingestion, bis(dimethylthiocarbamoyl) disulfide (TMTD) is found in the liver and spleen together with its metabolites: amine salt dimethyldithiocarbamic acid (DDCA) and tetramethylthiourea, and in the lungs, carbon disulfide and the amine salt of DDCA. TMTD is known to form N-nitrosodimethylamine by reaction with nitrite in mildly acid solution. TMTD and the amine salt of DDCA are excreted from the body in the urine and feces, and as carbon disulfide via the lungs. After absorption (respiratory, dermal, gastrointestinal), thiram is distributed in all organs and is mainly excreted unchanged in urine and feces. Some metabolism exists; carbon dioxide is exhaled and dithiocarbamate is excreted in urine. In studies with ruminant animals fed corn treated with thiram, rumen microorganisms degraded thiram to carbon disulfide and probably hydrogen sulfide and dimethylamine. Some unchanged thiram was also observed in feces and urine.
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Potential Hazards
Pesticides and nitrites in food may be a hazard to man, since many pesticides are secondary or tertiary amines, which form nitroso compounds in the presence of nitrite under conditions resembling those in the human stomach. Compounds were incubated for 4 hours at 37 C in the presence of excess nitrite at pH 3. Thiram converted to the carcinogen dimethylnitrosamine at a yield of 9%. The major metabolite in plants is ethylene thiourea, followed by ethylene thiuram monosulfide and presumably ethylene thiuram disulfide and sulfur. The hepatotoxic effects of thiram metabolism to carbon disulfide were investigated in rats. Male Sprague-Dawley rats were administered 15, 30 or 60 mg/kg thiram ip. Activities of serum glutamic oxaloacetic transaminase and sorbitol dehydrogenase were measured in the blood to assess the extent of liver injury. Detectable amounts of carbon disulfide appeared after 1.5 to 2 hr of treatment; 5 hr were required for complete recovery of carbon disulfide produced from 60 mg/kg thiram. A 2 fold increase in the dose of thiram from 15 to 30 mg/kg resulted in a 10 fold increase in the amount of carbon disulfide in expired air. Increasing the thiram dose 4 times to 60 mg/kg resulted in a 40 fold increase in carbon disulfide production over that from a 15 mg/kg thiram dose. The microsomal inhibitor SKF-525A inhibited the formation of carbon disulfide from thiram; phenobarbital treatment increased the formation of carbon disulfide. Thiram caused a significant loss of cytochrome P450 and benzphetamine-N-demethylase activity at 24 hr following treatment. Inhibition of hepatic dehydrogenases results in an acetaldehyde reaction on exposure to ethanol. Other effects may result from the known reactions of dithiocarbamates with metals, sulfhydryl-containing enzymes, or metabolism to reactive metabolites including carbon disulfide. Ingestion of the fungicide thiram (125 mg/kg) has been reported to evoke ovarian atrophy and cessation of egg laying in hens, presumably through inhibition of dopamine beta-hydroxylase. Disulfiram impairs the permeability of inner mitochondrial membrane (IMM). It was found that mitochondria metabolize thiram disulfide compounds (TDs) in a NAD(P)H- and GSH-dependent manner. At the concentration above characteristic threshold, TDs induced irreversible oxidation of NAD(P)H and glutathione (GSH) pools, collapse of transmembrane potential, and inhibition of oxidative phosphorylation. The presence of Ca(2+) and exhaustion of mitochondrial glutathione (GSH+GSSG) decreased the threshold concentration of TDs.
Puralin and Weight Loss
There is no evidence to support the use of Puralin (Thiram) as a weight loss ingredient. Its primary applications are in industrial and agricultural settings, and it may have potential hazards.
Current Medical Approaches to Weight Loss
Determining Candidacy for Weight Loss Medications
The initial step in determining if someone is a candidate for weight loss medications involves assessing their Body Mass Index (BMI). The guidelines for tirzepatide (Zepbound) and semaglutide (Wegovy) state that a patient should have a BMI of 30 or a BMI of 27 with weight-related health problems. For each individual case, the doctor and patient should discuss the patient’s current health issues, other medications, and family medical history. While some weight loss medications are FDA-approved only for adults, some-including semaglutide and liraglutide-are approved for children 12 and older with a BMI >/= 95th percentile. It can be easy to overlook first-generation AOMs, but these may be appropriate for some patients, especially when cost is a factor.
FDA-Approved Medications for Long-Term Use
Several medications have been approved by the FDA for long-term weight management. These include:
- Orlistat (Xenical, Alli): This is also the only over-the-counter medicine for weight loss currently approved by the FDA. As a lipase inhibitor, orlistat prevents the absorption of some dietary fat, which is then passed through the body. Some patients may lose about 5% of their body weight. An over-the-counter formulation is available at 60 mg capsules with each fat-containing meal.
- Phentermine-Topiramate (Qsymia): Topiramate can be combined with phentermine to decrease appetite and cravings. Adults with migraines and obesity are good candidates for this weight-loss medication. Some patients may lose an average of 5-10% of body weight. Daily doses with four strengths start at 3.75 mg/23 mg to 15 mg/92 mg.
- Naltrexone-Bupropion (Contrave): This combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite. Start with a daily dose of one 8/90 mg tablet and gradually increase to four tablets a day.
- Liraglutide (Saxenda): This is a daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals. Doses start at 0.6 mg to 3 mg a day. Some patients may lose 5-10% of body weight, especially with the higher dose of liraglutide. Liraglutide is also approved for Type 2 Diabetes, under the brand name Victoza.
- Semaglutide (Wegovy, Ozempic): Wegovy is a brand name for semaglutide, a GLP-1 receptor agonist. It was FDA-approved in 2021. It is administered as an injection and approved for use in adults and children aged 12 years or more with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children) or some adults with excess weight (BMI ≥27) who also have weight-related medical problems. The dose must be increased gradually over 16 to 20 weeks to arrive at the 2.4 mg dosage. This progression can help to alleviate side effects, which include gastrointestinal symptoms, headache, dizziness, and fatigue. Ozempic may be a more familiar name to some patients.
- Tirzepatide (Zepbound, Mounjaro): Zepbound is approved to treat obesity in adults with a BMI of 30 or greater. It is both a GLP-1 and a GIP receptor agonist. Like semaglutide, it works by reducing appetite and is meant to be used in combination with diet and exercise to lose weight. In the SURMOUNT-1 trial, adults with obesity or overweight (without diabetes) taking tirzepatide achieved up to 22.5% average body weight reduction at 72 weeks. Tirzepatide is a dual GIP and GLP-1 receptor agonist that suppresses appetite, improves satiety, and supports metabolic health.
Emerging Medications and Future Trends
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026 specifically for obesity. Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. It could provide a welcome alternative for people who do not want injections. Phase 3 results expected soon at 36 weeks. The other, retatrutide, targets GLP-1, GIP, and glucagon. At this writing, it is in Phase 3 clinical trials. In Phase 2, participants lost up to 24.2% of body weight at 48 weeks. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. The once-monthly injection entered Phase 3 clinical trials in March 2025. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication. Those of interest include not only GLP-1, but also peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK).
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Important Considerations Regarding Weight Loss Medications
- Average Weight Loss: The average weight loss varies from 5% to 21%, with some people losing more and some people losing less. Most people regain weight if AOMs are discontinued. AOMs may counter the effects of metabolic adaptation and prevent weight regain. After weight reduction, the body metabolically adapts, often causing an increase in hunger hormones and a decrease in satiety hormones and resting metabolic rate, all of which can contribute to weight regain.
- Treatment Plan: A treatment plan for obesity can comprise multiple forms of treatment, including medications, diet, exercise, and/or surgery. All weight loss medications work best in the context of a healthy eating plan and exercise.
- Insurance Coverage: Insurance coverage varies and will affect many patients’ choices about going on weight loss medications. GLP-1s are notoriously costly. The Kaiser Family Foundation estimates the annual net price of Wegovy at $13,600 and are not covered by insurance. provides Zepbound (tirzepatide) single-dose vial access for the 7.5 mg, 10 mg, 12.5 mg, and 15 mg doses-starting with refill eligibility within 45 days of delivery.
- Compounded Medications: Some online healthcare providers claim to sell Ozempic, Wegovy, or Zepbound at reduced prices. However, the FDA warns against buying medications from any source other than a state-licensed pharmacy. In April 2025, they banned the sale of “counterfeit” semaglutide and tirzepatide. These medications are not made or packaged by the original manufacturers. Instead, they are compounded medications. Compounded versions of medications are made by compounding pharmacies, often to tailor a medication to specific patient needs, like an allergy to an inactive ingredient. Compounded medications are not FDA-approved due to shortages. Some patients have taken these alternatives, which are generally more affordable, without ill effects. has received 520 reports of adverse events associated with compounded semaglutide and 480 reports of adverse events associated with compounded tirzepatide (as of April 30, 2025).
The Role of Lifestyle Changes
All weight loss medications work best in the context of a healthy eating plan and exercise.
Addressing Weight Gain from Other Medications
There are many medications that can be obesogenic or cause weight gain. Antidepressants are broken down into categories: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAO inhibitors), and others. In the SSRI group, paroxetine shows the highest associated weight gain. Weight-positive medications in the tricyclic antidepressant category include amitriptyline, doxepin, and imipramine. Bupropion (Wellbutrin), an aminoketone, is considered weight-negative and is prescribed both to assist in weight loss and to treat depression.
The Importance of Professional Guidance
With prescription medications, a healthcare professional can weigh all factors affecting the patient’s lifestyle and BMI and monitor progress and side effects. While no specific vitamin or supplement is considered a “treatment” for obesity or overweight, certain ones help support metabolic health. For example, studies suggest that calcium and vitamin D may play a role in regulating belly fat, and have been proposed for how this works.
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