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A Review of the Weight Loss Medications Medical Minute 21

A Review of the Weight Loss Medications

Hi, I’m Dr. Craig Primack from Scottsdale Weight Loss Center. Today for Medical Minute, Number 21, I’m going to spend a few minutes talking about the different weight loss drugs we use, why we use them and a few tips about each.


The first weight loss drug that we use is called Phentermine. Phentermine has been out since 1959. It’s really stood the test of time. Phentermine has two benefits. Number one, it’s great for taking appetite away. It works on a part of the brain called the hypothalamus. It’s the appetite center of the brain. And number two, we believe very gently, very mildly, it does increase metabolism. It does have two side effects. It is a mild stimulant drug. So for the first two or three nights, you may lose some sleep. Usually after that, you should be sleeping as well, or as lousy as you’ve been sleeping in the past. And then also sometimes a little bit of a dry mouth. Phentermine comes in many formulations from an 8 milligram to a 15 milligram to a 30 milligram and a 37.5 milligram. It comes in tablets and capsules.


The second medicine commonly used is called Diethypropion, sometimes called Tenuate. Tenuate also came out in 1959. Think of it as a milder, shorter acting Phentermine. Usually, it comes in two forms, a 25 milligram immediate release or a 75 milligram extended release. It can be used in the morning, in the afternoon, evening, all three, or especially sometimes we call it the “going out to dinner pill”. It can be used in the evening hours to get us through the dinner that early afternoon, sorry … The early evening, but without interfering with our sleep. Compared to Phentermine it’s side effects are very, very minor, and is used all the time. Sometimes even with Phentermine.


The next medicine to come out was in 2012. It’s called Qsymia. Qsymia is actually Phentermine, like I’ve just talked about, but also a medicine called Topiramate. What sets Qsymia apart from the rest is in the studies, at least to get it launched, it is the most potent weight loss drug that we have. Phentermine as we know, is a mild stimulant drug.

Topiramate, initially, was an anti-seizure drug, but it’s working on another part of the brain or what we think is the GABA system. There are at least four different doses used in this drug at different times. And on top of Phentermine, the only side effect that’s of note is some people do get a little forgetfulness, or maybe the word is word finding problems, and have trouble bringing a word out of their memory. You still know the memory, you still know the word, but it’s hard to get it out.


The next medicine to come out in 2015, there are actually two of them. One is called Contrave. Contrave is a combination of Wellbutrin with Naltrexone. It’s working for appetite and cravings. That’s what makes Contrave standout: cravings. It is a pill at 8 milligrams of Naltrexone and 90 milligrams of Wellbutrin. And by the end of the titration schedule, you do take four tablets a day, two in the morning and two at night. The biggest side effect, it’s seen in about one out of three people is nausea, but most people can get past it with a little dose titration and a little counseling along the way.


The fourth medicine I’ll talk about today is Saxenda. Saxenda is a hormone called GLP-1. It’s very good for appetite. It’s very good if you have blood sugar and other problems along with it. Well, one side effect that people wanted to know about is it does cause nausea and/or constipation. Sometimes a little what’s called gastroparesis. Saxenda is an injection. But trust me, most people, I pinched myself here and I say, “This injection actually hurts less than what I just did to pinch myself.” It is given daily at about the same time. And unfortunately, it is actually quite expensive if your insurance doesn’t cover it.


The last one on the market is just about to be released nationally, but has been released in limited fashion right now called Plenity. Plenity is actually not a weight loss medication, but it is a weight loss pill. It’s what’s called a Hydrogel or an absorbent Hydrogel. And you take three capsules before lunch, about 20 minutes, three capsules before dinner, in your stomach, the capsules break open. The Hydrogel absorbs water, about 16 ounces that you just drink, filling your stomach about this much. Make you feel a little more full than you did without eating these capsules or without taking these capsules.

Quick Summary @4:42

The main benefit of Phentermine, it seems to be the best for appetite control.  For Contrave the main benefit is both hunger and cravings. The main key for Saxenda is hunger control that lasts 24 hours.   Plenity’s key benefit, it is not systemically absorbed. Tenuate’s  main benefit is it is short-acting, can be used in the evening hours if you need it just in the evening hours. And it doesn’t have some of the stimulatory side effects that Phentermine may have.

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