Anti Obesity Medications

What are Anti Obesity Medications?


Anti Obesity Medications have been available in Australia and throughout the world for several decades.


These medications included oral medications such as Xenical, Duromine, Contrave, Metformin, Topiramate.


More recently injectable weight loss medications have become available that mimic certain GUT Hormones (Hormone GLP1) that control appetite and how we feel when we eat. These include Trulicity, Saxenda, Ozempic, Wegovy, and Mounjaro.


In Australia, Anti Obesity Medications can be prescribed by doctors such as General Practitioners, Endocrinologists, Bariatric Physicians and Bariatric Surgeons.


Your Doctor will choose which medication may be most suitable for you. As with most medications, there are some potential side effects that may vary depending on yourself and on the product.


Most Anti Obesity Medications are not PBS listed and carry a significant cost.


As with most medications, the effect of the Anti Obesity Medication wears off once the medication has ceased.


Types of Anti Obesity Medications


TABLETS:


  • Duromine
  • Topiramate
  • Contrave 
  • Metformin


INJECTIONS:


  • Trulicity 
  • Saxenda
  • Ozempic
  • Wegovy
  • Mounjaro    

How Do Anti Obesity Medications Work?


Medications which are taken orally as a tablet form such as Metformin, Duromine,  Contrave, and Topiramate all work in different ways according to the particular medication. Generally, these medications reduce a patient's appetite and may reduce cravings.


Injectable weight loss medications mimic certain GUT Hormones (Hormone GLP1) that control appetite and how we feel when we eat. They often cause patients to snack less and eat smaller portions. These medications include Trulicity, Saxenda, Ozempic, Wegovy, and Mounjaro.


What are the Advantages of Anti Obesity Medications?


The benefits of Anti Obesity Medications are often improved if patients combine these with a healthy diet, healthy eating behaviours and regular physical activity.


GLP1 AGONIST (Ozempic, Wegovy, Mounjaro, Saxenda, Trulicity) MEDICATIONS-EFFECTS ON THE BODY

* Decreased appetite

* Decreased food intake

* Increased Satiety

* Decreased body weight

* Increased Insulin

* Decreased hyperglycaemia

* Increased Insulin sensitivity

* Decreased gastric emptying - slower emptying of stomach


GLP1 AGONIST (Ozempic, Wegovy, Mounjaro, Saxenda, Trulicity) MEDICATIONS-BENEFITS TO HEALTH

* Decreased death from cardio-vascular disease

* Decreased incidence of heart attack

* Decreased incidence of stroke

* Decreased blood pressure

* Decreased fatty liver disease

* Decreased inflammation

* Decreased body weight




WHAT ARE THE DISADVANTAGES OF INJECTABLE WEIGHT LOSS MEDICATIONS (GLP1 AGONISTS)

Most Anti Obesity Medications are not PBS listed and carry a significant cost

The high cost associated with taking Anti Obesity Medications long term often leads to many patients having to stop these medications

Up to 1/3 patients have ceased OAMs by 1 month in some practices due to cost or side effects

Up to 2/3 patients have ceased OAMs by 3 months in some practices due to cost or side effects

Patients are more likely to cease medications if not prescribed by a specialist

Many patients regain their lost weight within 12 months of ceasing medications

Anti Obesity Medications may need to be ceased if certain side effects occur

As with certain medications, the effect of Anti Obesity Medications may diminish over time in some patients


Disadvantages of Injectable Weight Loss Medications (GLP1 Agonists)

AVOID or USE CAUTIOUSLY

Medullary Thyroid Carcinoma, MEN2

History of Pancreatitis

Severe GI disorders (eg. Gastroparesis)

Pregnancy


POSSIBLE ADVERSE EFFECTS/ POSSIBLE SIDE EFFECTS OF INJECTABLE WEIGHT LOSS  MEDICATIONS (GLP1 AGONISTS):

Nausea, Vomiting, Diarrhoea, Early Satiety

Pancreatitis

Gallstones

Delayed Gastric Emptying

Thyroid C cell tumours

Acute Kidney Injury

Hypoglycaemia


When to use different Anti-Obesity Medications:

HUNGER CONTROL, PORTION CONTROL - GLP1’s - Saxenda, Ozempic, Wegovy, Mounjaro

SNACKING AND CRAVING - Contrave

SWEET CRAVING AND FATIGUE- Phentermine 

SWEET CRAVING / HEADACHES- Topiramate 

WEIGHT REGAIN FROM MENTAL HEALTH MEDICATIONS -Metformin



 

GLP1 AGONIST MEDICATIONS-INDICATIONS FOR USE

BMI>27 WITH COMORBIDITIES OR BMI>30 WITH NO COMORBIDITIES

Not a candidate for surgery

Preoperatively for BMI>60

Within 3months Weight Loss Surgery if not on expected weight loss curve

Weight regain post Weight Loss Surgery




TABLETS:


DUROMINE:

Phentermine

Dosage: 15-30mg weekly

Not PBS listed

Expected weight loss: - 12 weeks of treatment - 5-10% TWL   (Kang et al. 2010)

Cost per Month: $90-$170/month - depending on dose and place of purchase

Cost per Year: $1,080-$2,040/year - depending on dose and place of purchase



CONTRAVE:

Naltrexone/Bupropion

Dosage: 8mg/90mg daily - dose increases from 1-4 tablets/d

Not PBS listed

Expected Weight Loss: - 56 weeks of treatment - 5.4% TWL   (Greenway et al. 2010)

Cost per Month: $249/month - depending on dose and place of purchase

Cost per Year: $2,988/year - depending on dose and place of purchase


TOPAMAX:

Topiramate

25mg -200mg daily

TGA approved for migraines and epilepsy

Not PBS listed

Bray et al. 2003 -24weeks of treatment - 5% TWL

$10-$23/month - depending on dose and place of purchase

$60-$141/year - depending on dose and place of purchase



MOUNJARO:

Tirzepatide 

2.5mg – 15mg weekly

TGA approved for T2DM

Not PBS listed

Surmount Trial - 72 weeks of treatment - 15-20.9% TWL

$285-$719/month - depending on dose and place of purchase

$3,420-$8,628/year - depending on dose and place of purchase


WEGOVY:

Semaglutide

0.25mg-2.4mg weekly

TGA approved for weight loss

Not PBS listed

Step1-4,5,8 and Select Trials - 68-208 weeks of treatment - 14.9-18.5% TWL

$260-$645/month - depending on dose and place of purchase

$3,120-$7,740/year - depending on dose and place of purchase


OZEMPIC:

Semaglutide

0.25mg – 1mg weekly

PBS listed for T2DM

Not PBS listed for weight loss

Sustain 7 Trials- 40 weeks of treatment - 6.5% TWL

$130-$200/month - depending on dose and place of purchase

$1,560-$2,400/year - depending on dose and place of purchase



SAXENDA:

Liraglutide

0.6mg – 3mg daily

TGA approved for weight loss

Not PBS listed for weight loss

Step 8, Scale and Leader Trials- 56-68 weeks of treatment - 6.4-8% TWL

$400/month - depending on dose and place of purchase

$4,800/year - depending on dose and place of purchase



TRULICITY:

Dulaglutide

1.5mg weekly

TGA approved for weight loss

PBS listed for T2DM

Sustain 7 Trial- 40 weeks of treatment - 3% TWL

$150/month - depending on place of purchase

$1,800/year - depending on place of purchase