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The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medicines for obesity should not be used alone. Rather, they should be part of a a comprehensive weight loss program that includes:

  • Reduced caloric intake
  • Regular exercise and other behavior changes
  • Psychological counseling (if needed)

Prescription Medications
Central Nervous System Medications

Common names include:

  • Phentermine (Profast, Fastin, Ionamin, Adipex-P)
  • Phendimetrazine (Bontril)
  • Diethylpropion (Tenuate, Dospan)
  • Phentermine plus extended release topiramate (Qsymia)
  • Lorcaserin (Belviq)

These medicines act on your brain to suppress your appetite. Phentermine, phendimetrazine and diethylpropion are only recommended for short-term use (a few weeks).

Possible side effects include:

  • Phentermine:
    • Elevation of blood pressure
    • Heart problems
    • Sleeplessness
    • Nervousness
    • Headache
    • Dry mouth
    • Problems with stomach or intestines such as nausea, diarrhea , or constipation
    • Difficulty urinating
    • Rash
    • Restlessness
    • Dizziness
  • Phendimetrazine
    • Sleeplessness
    • Nervousness
  • Diethylpropion:
    • Nervousness
    • Sleeplessness
    • Headache
    • Dizziness
  • Phentermine plus extended release topiramate
    • Elevation of blood pressure
    • Heart problems
    • Sleeplessness
    • Nervousness or irritability
    • Numbness or tingling of skin
    • Change in taste
    • Depression
  • Lorcaserin
    • Dizziness
    • Headache
    • Fatigue
    • Nausea
    • Dry mouth
    • Constipation
    • Back pain
    • Cough

Fat Absorption Blockers

Common names include: orlistat , available as;

  • Xenical (prescription)
  • Alli (over-the-counter)

Taken at a dose of 120 milligrams three times a day, Xenical prevents ingested fat from being absorbed by blocking digestive enzymes. About 30% of the fat you eat will remain in your bowels. In some patients the fat is excreted by the body between bowel movements as an oily discharge. It is recommended for long-term use (up to about two years). Orlistat is also available in a 60-mg over-the-counter form, called Alli.

Possible side effects include:

  • Staining of underwear
  • Gas
  • Pressure to empty bowels
  • Leakage of stool
  • Increased frequency of bowel movements
  • Severe liver damage (rare side effect)

Over-the-Counter (OTC) Medications

OTC medicines advertised as promoting weight loss are generally considered ineffective. Some have led to serious side effects. Do not use over-the-counter or herbal remedies without talking to your doctor.

To view the latest product safety warnings and recalls, visit the Food and Drug Administration's website .

Special Considerations

If you are taking medicines, follow these general guidelines:

  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you don’t run out.

References:

Arterburn DE, Crane PK, Veenstra DI. The efficacy and safety of sibutramine for weight loss: a systematic review. Arch Intern Med. 2004;164:994-1003.

Facts and comparisons. Drug Facts and Comparisons . 56th ed. St. Louis, MO: Facts and Comparisons; 2001.

Haddock CK, Poston WSW, Dill PL, Foreyt JP, Ericsson M. Pharmacotherapy for obesity: a quantitative analysis of four decades of published randomized clinical trials. Int J Obes Relat Meta Disord. 2002;26:263-273.

Li Z, Maglione M, Mojica W, Arterburn D, et al. Meta-analysis: Pharmacologic treatment of obesity. Ann Intern Med. 2005;142:532-546.

Obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 16, 2012. Accessed August 28, 2012.

Obesity in children and adolescents. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 25, 2012. Accessed August 28, 2012.

Phentermine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 14, 2011. Accessed August 28, 2012.

Prescription medications for the tretment of obesity. National Institute of Diabetes and Digestive and Kidney Diseases. Available at: http://win.niddk.nih.gov/publications/prescription.htm#meds . Accessed August 28, 2012.

Snow V, Barry P, Fitteman N, Qaseem A, et al. Pharmacologic and surgical management of obesity in primary care: a clinical practice guidelines from the American College of Physicians. Ann Intern Med. 2005;142:525-531.

Weight loss medications for obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated July 18, 2012. Accessed August 28, 2012.

Wirth A, Krause J. Long-term weight loss with sibutramine: A randomized controlled trial. JAMA . 2001;286:1331-1339.

11/20/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Pai You Guo, marketed as dietary supplement—recall. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm190531.htm . Published November 13, 2009. Accessed November 20, 2009.

1/22/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Meridia (sibutramine hydrochloride): follow-up to an early communication about an ongoing safety review. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198221.htm . Published January 21, 2010. Accessed January 22, 2010.

5/28/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Orlistat (marketed as Alli and Xenical): labeling change. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm213448.htm . Published March 26, 2010. Accessed March 28, 2010.

9/17/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : James WP, Caterson ID, Coutinho W, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905-917.

10/15/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : US Food and Drug Administration. Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm . Published October 8, 2010. Accessed October 15, 2010.



Last reviewed September 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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