Selection of an antiobesity medication

This algorithm outlines an approach to choosing a medication to treat obesity that prioritizes medication efficacy, cost considerations, and key contraindications. Medications in each box are listed in order of efficacy. It should be used in conjunction with UpToDate topics on drug therapy for obesity in adults, which discuss the efficacy, safety, administration, and monitoring of different antiobesity medications. Refer to UpToDate tables on medication dosing for treatment of patients with obesity and drug monographs included within UpToDate for detailed dose initiation, titration, and target dose recommendations.

ASCVD: atherosclerotic cardiovascular disease; BMI: body mass index; CVD: cardiovascular disease; DM: diabetes mellitus; MAOI: monoamine oxidase inhibitor; MEN2: multiple endocrine neoplasia, type 2; SGLT2: sodium-glucose cotransporter 2.

* Semaglutide reduces ASCVD outcomes in those with established CVD. Liraglutide and dulaglutide reduce ASCVD outcomes in those with type 2 DM and established or high risk of CVD. Reductions in cardiovascular outcomes have not been established for tirzepatide.

¶ In the United States, these medications can be obtained separately as generic versions that are less expensive than their combination versions.

Δ Phentermine is approved for short-term use (3 months) for the treatment of obesity. In the United States, use of generic version may be less expensive.

◊ For patients with type 2 DM and obesity who have medication coverage for diabetes (but not antiobesity) medicines, we use diabetes treatment doses (eg, semaglutide 2 mg once weekly or liraglutide 1.8 mg once daily).

§ Subcutaneous agents are generally more effective than oral agents, except that exenatide may be less effective for weight loss than phentermine-topiramate.

Graphic 144356 Version 2.0

خرید پکیج

Selection of an antiobesity medication