Pharmacological treatment of obesity in clinical practice

Abstract

Anti-obesity medications may be considered in the subjects with BMI ≥30 kg/m2, or with BMI 27-29.9 kg/m2 and weight-related comorbidities, whom weight reduction is not achieved via lifestyle modifications alone. If weight loss is inadequate (<4-5%) after 12 weeks of treatment, the medication should be changed. Orlistat and Lira-glutide are available in our country. Orlistat inhibits pancreatic lipase, increases fat excretion, improves hypertension or lipid profile besides weight-reduction. No dosage adjustment is necessary in renal or liver impairment. Orlistat may lead flatus, intestinal cramps, fecal incontinence, oily spotting, and should not be used in malabsorption syndrome, cholestasis, or pregnancy. Liraglutide is a biochemically modified GLP1 which slows gastric emptying and decreases appetite. It is preferred as a first-line agent in most situations. It was shown to decrease major cardiovascular events. Liraglutide is initiated once a day subcutaneously 0.6 mg/day, then dose is increased up to 3mg/ day. Nausea and vomiting are common with liraglutide, renal impairment, gallbladder disease or pancreatitis less common. Liraglutide is contraindicated in pregnancy, lactation, MEN 2 or medullary thyroid cancer. Phentermine/topiramate combination may be considered in subjects without any cardiovascular diseases who do not tolerate liraglutide or orlistat. It is contraindicated in pregnancy due to a risk of orofacial defects, and not recommended in hypertension, coronary heart disease, hyperthyroidism or monoamine oxidase use. Bupropion/Naltrexone combination provides anorexigenic effect by acting on feeding and reward circuitry. It may be preferred if pharmacological therapy both for smoking cessation and weight loss is desired. Vomiting, constipation, dry mouth or suicidal thoughts may be observed, and contraindicated in pregnancy, seizure, uncontrolled hypertension, opioid or monoamine oxidase inhibitor use. Phentermine, diethylpropion, benzphetamine, and phendimetrazine are used for short-term due to risk of abuse, and contraindicated in uncontrolled hypertension, coronary heart disease, or thyrotoxicosis. Safety of dietary supplements used for obesity is limited.

Full text

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REVIEW ARTICLE
Medicine Science 2021;10(2):651-7
Pharmacological treatment of obesity in clinical practice
Omercan Topaloglu1, Ibrahim Sahin2
1Zonguldak Bulent Ecevit University, Faculty of Medicine, Department of Endocrinology and Metabolism, Zonguldak, Turkey
2Inonu University, Faculty of Medicine, Department of Endocrinology and Metabolism Malatya, Turkey
Received 02 May 2021; Accepted 16 May 2021
Available online 20.05.2021 with doi: 10.5455/medscience.2021.05.151
Copyright@Author(s) - Available online at www.medicinescience.org
Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Abstract

-
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      

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         -
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

obesity is limited.
Keywords: 
Introduction
 
        
 


    
     
      
         
burden in many countries.

            
m together with comorbidities. Weight reduction was shown to
decrease morbidities associated with obesity. Weight loss may also
provide a reduction in mortality associated with obesity.
        
and reverse the complications and comorbidities associated
      

  
          
        
         


An appropriate anti-obesity medication should provide a
        
Medicine Science
International
Medical Journal
*Corresponding Author:     
   
mail: drhomercan@hotmail.com

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and weight loss should be continued even after cessation of the

even in the continuation of the medication. Weight regain is a
       
        
         
response to a medication may be varied for each patient. An anti-
obesity medication ideally should contribute to a decrease in health


      
considered for every patient either alone or in combination with
pharmacological treatment and/or bariatric surgery.
        
       


          

       
       
factors may have also a role in the adjustment of the dose or
       
patients whom anti-obesity medications were indicated should be

     


associated with obesity.
       
after the initiation of the anti-obesity medication. If weight loss
       
         
not certain for it to respond to another drug or combination of
         
response improving comorbidities. Weight management should
      
       
 


Pharmacological Agents Used In The Treatment Of Obesity
Several oral or injectable forms of anti-obesity medications were
approved and may be used in the pharmacological treatment of

  
      


doi: 10.5455/medscience.2021.05.151 Med Science 2020;10(2):651-7
Table 1. Pharmacological agents used in obesity
Generic Name Dosage Side Eects Turkey
Orlistat 

vitamins reduced.

Contraindicated in pregnancy.
Available
Liraglutide
Intial: 0.6 mg/day subcutaneous







-


Available
Phentermine/
topiramate






Abuse potential due to phentermine component.
-
ponent include inhibition of carbonic anhydrase; rarely metabolic acidosis






Not available
Bupropion/nal-
trexone


ndrd
at 4th


-


Not available


       
     


         
  
  
     

Anti-obesity medications should be selected on the basis of body
     
       
         
agent in the treatment of obesity.
Orlistat
         
 

        
        

of ingested dose may be absorbed.
      
     
         



  
st


        
        



blood pressure in hypertensive obese patients. Reduction in





Recommended oral orlistat dosage is 120 mg three times a day.
          
          
hour) each main meal. Interval of 2-hour should be provided
        
         
impairment.


            
         
         
cardiovascular or central nervous system events were not shown
  
But causal relationship between liver injury and orlistat use could

        
       
        
      



        


       



         

Noradrenergic sympathometic drugs
Benzphetamine



Limit short-term use.

Abuse potential

abuse.


Not available
Diethylpropion 
 Not available
Phentermine 
 Not available
Phendimetrazine



Not available
doi: 10.5455/medscience.2021.05.151 Med Science 2020;10(2):651-7

654
Liraglutide
   
      
        
     

      
        
    
     
together with oral antidiabetic medications. Liraglutide is a




      
         
        
         
         



      
      
       
       
         
        

         

increase thermogenesis. Main mechanism of liraglutide is through
         
central nervous and gastrointestinal systems.

 
         

         

          
           
120 mg three times daily in 564 patients with obesity but without
          
increased with increasing doses of liraglutide. At higher doses of

           

       
      




Liraglutide was shown to decrease major cardiovascular events
            
       

Liraglutide is administered once a day and subcutaneously in


  
       
  
     

        
       
         

        
        
         
         
        
      
        
        
was shown to increase benign or malignant thyroid C-cell tumors.
        

       

  

or previous hypersensitivity to liraglutide are contraindications
         

be necessary if liraglutide is added to the treatment.
Phentermine/Topiramate
         
       
         
control. Several combination preparations are available.
   
        
       

and increase satiety. It may be considered in the treatment of
postmenopausal women or men without any cardiovascular
diseases who do not tolerate liraglutide or orlistat.

      
        
        
      
     

doi: 10.5455/medscience.2021.05.151 Med Science 2020;10(2):651-7

655
            
          
            

  



or increased heart rate may be observed.

       
the initiation of the treatment with phentermine/topiramate in
reproductive women. It is not recommended in the patients with

       
       
used in the presence of personal history of renal stones.
Bupropion/Naltrexone

       
         
     
         
         

of opioid-receptor and may be used in the treatment of alcohol and
   

     
   
weight loss.
      


         
         

       
not complete the treatment duration until to the end of the study.
           

th 

      
         
       
         
       
outcomes. It may be associated also with suicidal thoughts and
        
       


Cardiovascular safety of this combination has not been established
        
aiming to assess cardiovascular outcomes of this combination was



 
inhibitors in the last 14 days.
Sympathomimetic Drugs
          
        
       
       


for abuse.

        
   


   

     
       

and all of them may be associated with increased blood pressure.
         



       
         

was shown to provide more weight loss comparing to placebo in a

         

was shown to lead an increase in systolic and diastolic blood

      
       
       
       
      
       
added to dietary supplements which did aim weight reduction.


Therapies Not Approved
Lorcaserin
        

doi: 10.5455/medscience.2021.05.151 Med Science 2020;10(2):651-7

656
        


  


 

Dietary Supplements
     


       
      


Conclusion
Management of obesity necessitates multiple methods such
       
pharmacological intervention and bariatric surgery in some patients.

  

       




      
  
        
liraglutide was not under reimbursement policy in our country. New

available in future both in our country and the world.
Conict of interests
Authors declare that there is no conict of interest.
Financial Disclosure
All authors declare no nancial support.
References
1.             
   
         

2.         

 

as an adjunct to lifestyle changes for the prevention of type 2 diabetes in

4.     


5.           
adaptive thermogenesis in subjects who havemaintained a reduced body

6.  

7.            

8.      
         

 


10.          
          

11. 
clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: the

12.            
    

 
14.            
treatment of obesity. Nature 2000;404:672.
15. 

16. 
relevant treatments for obesity in adults: asystematic evidence review for

17.     
  

18. 
carbohydrate diet vs orlistat plus a low-fat diet for weight loss. Arch Intern

 
        

20.           

21.        
         

22.         

 


24. 
         

25.  

26. 

27.            


28. 
      

 

 
weight loss with liraglutide after low-calorie-diet-induced weight loss: the

doi: 10.5455/medscience.2021.05.151 Med Science 2020;10(2):651-7

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          

 
     

      



 
 


 


 


           
        
      

        
        

40.     
  

41.          
bupropion sustained-release for the management ofobesity: review of the

42. 
       

          
      

44.          

45.   
       
      

46.         

47.     
       

48.            
        

    

50. 
  
      
2000;160:2185.
51.             
    

52.            
   

       

54.           
   

55.            


56.             


doi: 10.5455/medscience.2021.05.151 Med Science 2020;10(2):651-7