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Chapter 2


Box 2.16 Pharmacological Treatment of Obesity13 Orlistat


• Brand names: Xenical (prescription; 120 mg); Alli (over the counter; 60 mg).


• Principal action: An intestinal fat absorption inhibitor that inhibits pancreatic and gastric lipase


• Dosage: ○ Xenical: 120 mg three times daily (TID) with meals


○ Alli: 60–120 mg taken during or within 1 h after a meal containing some fat (no more than 30% of meal calories from fat), usually taken TID


• Weight loss: ○ Above diet and lifestyle alone: 2.1–3.4 kg (6.5–7.5 lb) ○ Mean weight loss: 2.9%–3.4%


• Common side effects: Decreased absorption of fat-soluble vitamins, steatorrhea, oily spotting, flatulence with discharge, fecal urgency, oily evacuation, increased defecation, fecal incontinence


Lorcaserin


• Brand name: Belviq • Principal action: A selective serotonin 2 C (C5HT2c) receptor agonist; targets hunger


• Dosage: 10 mg twice daily (BID)


• Weight loss: ○ Above diet and lifestyle alone: 3.6 kg (7.9 lb) ○ Mean weight loss: 3.6%


• Common side effects: Headache, nausea, dry mouth, dizzi- ness, fatigue, constipation


Phentermine (P)/topiramate (T)


• Brand name: Qnexa • Principal action: Combinations that may work on more than one brain mechanism; phentermine (adrenergic agonist) on energy need and topiramate on reward (want)


• Dosage: 7.5 mg (P)/46 mg (T) daily Continued on next page.


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