Biography
Biography: Basma Mandour
Abstract
Antiobesity pharmacotherapy is one strategy to offset the adaptive changes in appetite and energy expenditure that occur with weight loss and to improve adherence to lifestyle interventions. According to the 2013 American College of Cardiology/Amer-ican Heart Association/The Obesity Society's guideline for the management of overweight and obesity in adults and the Endocrine Society's clinical practice guidelines on the pharmacologic management of obesity, pharmacotherapy for obesity can be considered if patients have a body mass index (BMI) of 30 kg/m? or greater or a BMI of 27 kg/m~ or greater with weight-related comorbidities, such as hypertension, dyslipidemia, type 2 diabetes, and obstructive sleep apnea.
As obesity is a chronic disease, most antiobesity medications are approved is Phentermine was approved by the FDA in 1959 and has been the most commonly prescribed medication for obesity in the United States.
ORLISTAT
Before 2012, the only antiobesity medicine approved for long-term use was orlistat, which was approved by the FDA in 1999.
PHENTERMINE/TOPIRAMATE EXTENDED RELEASE
In 2012, the FDA approved phentermine/topiramate ER for chronic weight management as an adjunct to a reduced-calorie diet and increased physical activity.
LORCASERIN
Lorcaserin, a selective serotonin (5-hydroxytryptamine [5HT)-2C receptor agonist, was approved by the FDA in 2012 as a long-term treatment of obesity.
NALTREXONE SUSTAINED RELEASE/BUPROPION
Naltrexone/bupropion was approved for the treatment of obesity in 2014. Bupropion is a dopamine and norepinephrine reuptake inhibitor that was FDA approved as an antidepressant in 1989..
LIRAGLUTIDE 3.0 MG
Liraglutide 3.0 mg was the second agent approved by the FDA in 2014 for chronic weight management.
PRACTICAL TIPS FOR TREATMENT
important for primary care providers to be familiar with the pharmacotherapy available to patients who are unable to lose weight and sustain weight loss with lifestyle interventions alone.
There are 2 important questions to ask when prescribing an antiobesity medication to patients. The first question is whether there are undesirable side effects, contrain-dications, or drug-drug interactions. For example, avoid orlistat if patients have a condition predisposing to malabsorption and avoid phentermine and phentermine/ topiramate ER if patients have unstable coronary disease.
The second question is whether any of the medications could improve another symptom or condition.
Pharmacotherapy should not be prescribed in the absence of behavioral counseling focusing on diet, physical activity, and lifestyle modifications, which are the cornerstones of weight management.