The pharmacological treatment of obesity is a rapidly evolving field, and staying informed about the latest options is crucial. While prescription medications like phentermine have been widely used for weight loss, many individuals seek over-the-counter (OTC) alternatives. This article explores various OTC options that may offer similar benefits to phentermine, along with their mechanisms, efficacy, and potential risks.
The Rise of Weight Loss Medications
Before 2012, there were limited FDA-approved weight loss medications. However, the landscape has changed dramatically, with glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) gaining immense popularity in the 2020s. Drugs like Mounjaro and Zepbound have further expanded the options available for individuals seeking medical assistance with weight loss.
Determining candidacy for weight loss medications involves assessing factors like BMI, current health issues, other medications, and family medical history. While the average weight loss varies from 5% to 21%, it's important to note that most people regain weight if medications are discontinued.
Phentermine: A Widely Used Weight Loss Medication
Phentermine, approved by the FDA in 1959, is one of the oldest and most widely used weight loss medications. Initially intended for short-term use, it has now been incorporated into long-term therapy in newer medical guidelines. Phentermine is a sympathomimetic amine and part of a drug class called anorectics. It’s a central nervous system (CNS) stimulant that suppresses your appetite. Phentermine may help reduce your food cravings as an appetite suppressant and increase your metabolic rate so you burn body fat. It’s also chemically related to amphetamine and is a schedule IVcontrolled substance because of the potential risk for addiction.
However, phentermine is a controlled substance with a risk of abuse and dependence, those with a history of substance abuse disorder can’t take it at all. It has potential side effects, including headache, overstimulation, high blood pressure, insomnia, rapid or irregular heart rate, and tremor. This has led many to seek alternative options.
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Over-the-Counter Alternatives to Phentermine
While phentermine requires a prescription, several over-the-counter options are available for individuals seeking weight loss support.
Alli (Orlistat)
Alli (orlistat) is the only FDA-approved over-the-counter (OTC) weight loss aid for adults 18 and older with a BMI of 25 or more. It is half as strong as prescription orlistat (Xenical). It belongs to a class of drugs called lipase inhibitors. It blocks the intestines from absorbing about 25 percent of the fat you eat. This means that the fats that aren’t absorbed leave your body through bowel movements. When you take the drug with a meal, about 25% of the fat you eat isn't broken down.
Alli may help you lose weight. But the weight loss will likely be modest. In some studies, more than 40% of people taking Alli while following a calorie-restricted diet and increasing physical activity lost 5% or more of their body weight within a year.
You take one 60-milligram Alli pill within an hour of a fat-containing meal up to three times a day. You should spread your daily fat intake over the three main meals. Fat intake should be no more than 30% of total calories. If you eat a meal that has no fat, then you don't need a dose of Alli.
Alli can reduce the absorption of fat-soluble nutrients, including beta carotene and vitamins A, D, E and K. Take a multivitamin at least two hours after your last dose of Alli. The active ingredient in Alli, orlistat, causes digestive side effects related to undigested fats passing through your digestive system. They generally lessen over time and with proper use of the drug.
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Other OTC Options
Many other over-the-counter products claim to help with weight loss. These products have not been proven to be safe or effective. Other OTC products that claim to help with weight loss haven't been proven to be safe or effective and may be harmful. They may cause heart problems, stroke, kidney problems, cancer, or sexual problems. If you are thinking about trying an OTC weight-loss product, talk to your doctor first.
Natural Alternatives
If you want to hit your weight-loss goals with something other than a prescription weight-loss medication, you may want to reconsider. Of course, many phentermine alternative supplements claim they curb your sugar cravings, trigger fat loss, or come with a 60-day money-back guarantee. But many of those are false claims. In all actuality, weight-loss supplements that boast they burn fat, suppress appetite, and boost metabolism may do more harm than good. It’s easy to fall prey to some of the marketing ads out there, so be on the alert and consult with your doctor before you try anything new.
Be cautious of over-the-counter diet pills that include thermogenic ingredients like cayenne pepper, green tea extract, green coffee, vitamin B6, and guarana. Even though they may sound innocent, extensive studies on the safety and effectiveness of natural supplements for weight loss prove otherwise.
Some other natural ingredients to be on the lookout for-and speak to your health care professional about before trying-are L-theanine, glucomannan, L-tyrosine, chromium picolinate, garcinia cambogia, phenylalanine, and rhodiola rosea. Be sure to ask about name-brand weight-loss pills that say they increase energy levels and have fat-burning abilities as natural phentermine alternatives like PhenGold, PhenQ, Phen24, PrimeShred, Leanbean®, and Trimtone before you try them.
Prescription Appetite Suppressants for Long-Term Use
The Food and Drug Administration (FDA) has approved these prescription appetite suppressants for long-term use:
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- Liraglutide (Saxenda®). This is an under-the-skin (subcutaneous) injection medication.
- Semaglutide (Wegovy®). This is an under-the-skin injection medication.
- Naltrexone-bupropion (Contrave®). This is a pill.
- Phentermine-topiramate (Qsymia®). This is a pill.
Prescription Appetite Suppressants for Short-Term Use
Other FDA-approved prescription appetite suppressants are for short-term use only - typically up to 12 weeks (three months), including:
- Benzphetamine (Didrex®, Regimex®).
- Diethylpropion (Tenuate®, Tenuate Dospan®).
- Phendimetrazine (Prelu-2®).
- Phentermine (Dipex-P®, Atti-Plex P®, Pro-Fast® and others).
The Role of Lifestyle Changes
All weight loss medications, including OTC options, work best when combined with a healthy eating plan and regular exercise.
Important Considerations
- Consultation with a Healthcare Provider: It is crucial to consult with a healthcare professional before starting any weight loss medication, including OTC options. They can assess your individual needs, medical history, and potential risks and benefits.
- FDA Approval: Ensure that any weight loss medication you consider is FDA-approved for safety and effectiveness.
- Potential Side Effects: Be aware of the potential side effects of any medication and discuss them with your healthcare provider.
- Long-Term Use: Some weight management medications are designed for short-term use, while others are approved for long-term use. Discuss the appropriate duration of treatment with your healthcare provider.
- Comprehensive Treatment Plan: Remember that weight loss medications are most effective when used as part of a comprehensive treatment plan that includes lifestyle changes, such as diet and exercise.