Obesity Treatments

OBESITY TREATMENTS
Generic	Brand		Strength	Form	Dosing
CNS STIMULANT
amphetamine sulfate	Evekeo	CII	5mg, 10mg	tabs	Adults: Take 30–60mins before meals. Usually up to 30mg/day in divided doses of 5–10mg. Children: Not recommended.
GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONISTS
liraglutide	Saxenda	Rx	6mg/mL	SC inj	Give by SC inj into abdomen, thigh, or upper arm once daily. Escalate dose gradually. Week 1: 0.6mg daily; Week 2: 1.2mg daily; Week 3: 1.8mg daily; Week 4: 2.4mg daily; Week 5 and onward: 3mg daily. ≥12yrs: Lower escalation dose to previous level if increased dose not tolerated; dose escalation may take up to 8wks. Reduce maintenance dose to 2.4mg daily if 3mg not tolerated; discontinue if 2.4mg not tolerated. Evaluate response after 12wks. Discontinue if ≥1% weight loss is not achieved. ≥18yrs: Delay dose escalation 1wk if increased dose not tolerated; discontinue if 3mg not tolerated. If concurrent insulin secretagogues (eg, sulfonylureas) or insulin; consider reducing their doses by ½. Evaluate response after 16wks. Discontinue if ≥4% weight loss is not achieved. Both: If >3 days elapsed since last dose, reinitiate at 0.6mg/day, then follow dose escalation schedule. <12yrs: Not established.
semaglutide	Wegovy	Rx	0.25mg/0.5mL, 0.5mg/0.5mL, 1mg/0.5mL, 1.7mg/0.75mL, 2.4mg/0.75mL	SC inj	≥12yrs: Give by SC inj into abdomen, thigh, or upper arm; rotate inj sites. Escalate dose with the following schedule (to minimize GI effects): Weeks 1–4: 0.25mg once weekly; Weeks 5–8: 0.5mg once weekly; Weeks 9–12: 1mg once weekly; Week 13–16: 1.7mg once weekly; Week 17 and onward: 2.4mg once weekly (in children ≥12yrs), and 2.4mg (recommended) or 1.7mg once weekly in adults. Consider delaying dose escalation for 4wks if increased dose not tolerated. If the maintenance 2.4mg once-weekly dose is not tolerated, may reduce to 1.7mg once weekly. For children ≥12yrs: discontinue if the 1.7mg dose is not tolerated. <12yrs: Not established.
tirzepatide	Zepbound*	Rx	2.5mg/0.5mL, 5mg/0.5mL, 7.5mg/0.5mL, 10mg/0.5mL, 12.5mg/0.5mL, 15mg/0.5mL	SC inj	≥12yrs: Give by SC inj in abdomen, thigh, or upper arm; rotate inj sites. Initially 2.5mg once weekly; after 4wks, increase to 5mg once weekly. May increase in 2.5mg increments after ≥4wks on the current dose; max 15mg once weekly. <18yrs: Not established.
LIPASE INHIBITOR
orlistat	Alli	OTC	60mg	caps	≥18yrs: 1 cap with each fat-containing meal; max 180mg/day. Take multivitamin once daily at bedtime. <18yrs: Not recommended.
orlistat	Xenical	Rx	120mg	caps	≥12yrs: Use with a reduced calorie diet with about 30% of calories from fat; spread fat intake over 3 main meals. 120mg three times daily during or up to 1hr after each fat-containing meal. If a meal is missed or has no fat, skip dose. <12yrs: Not established.
MELANOCORTIN RECEPTOR AGONIST
setmelanotide	Imcivree^†	Rx	10mg/mL	soln for SC inj	≥12yrs: Initially 2mg once daily for 2wks. Target dose: 3mg once daily. If starting dose is not tolerated, reduce to 1mg once daily. If the 1mg once daily dosage is tolerated for ≥1wk, increase to 2mg once daily. If the starting dose is tolerated for 2wks, increase to 3mg once daily. Decrease to 2mg once daily if 3mg dose is not tolerated. 6–<12yrs: Initially 1mg once daily for 2wks. Target dose: 3mg once daily. If the starting dose is not tolerated, reduce to 0.5mg once daily. If the 0.5mg once daily dose is tolerated for ≥1wk, increase to 1mg once daily. If the starting dose is tolerated for 2wks, increase to 2mg once daily. Decrease to 1mg once daily if 2mg dose is not tolerated; increase to 3mg once daily if 2mg is tolerated. <6yrs: Not established.
OPIOID ANTAGONIST + AMINOKETONE
naltrexone HCl/ bupropion HCl	Contrave	Rx	8mg/ 90mg	ext-rel tabs	Avoid high-fat meals. Escalate dose gradually. ≥18yrs: Week 1: 1 tab daily in the AM; Week 2: 1 tab daily in the AM and 1 tab daily in the PM; Week 3: 2 tabs in the AM and 1 tab in the PM; Week 4 and thereafter: 2 tabs in the AM and 2 tabs in the PM. Max 32mg/360mg per day. Evaluate response after 12wks. Discontinue if ≥5% weight loss is not achieved. Concomitant CYP2B6 inhibitors, moderate or severe renal impairment, moderate hepatic impairment: max 2 tabs daily (1 tab each AM & PM). <18yrs: Not recommended.
SYMPATHOMIMETIC
benzphet– amine HCl	—	CIII	50mg	scored tabs	≥17yrs: Initially 25−50mg once daily in mid-morning or mid-afternoon. Increase if needed to 25−50mg 1−3 times daily. <17yrs: Not recommended.
diethylpro– pion HCl	—	CIV	25mg	tabs	>16yrs: 25mg 3 times daily 1hr before meals and in midevening for night hunger or one 75mg sust‑rel tab daily in midmorning. ≤16yrs: Not recommended.
diethylpro– pion HCl	—	CIV	75mg	sust-rel tabs
phendime– trazine – tartrate	—	CIII	105mg	ext-rel caps	≥17yrs: 1 cap in AM, 30−60mins before morning meal. <17yrs: Not recommended.
phendime– trazine – tartrate	—	CIII	35mg	scored tabs	Adults: 35mg 2–3 times daily, 1hr before meals; may reduce to 17.5mg/dose. Max 210mg/day in 3 divided doses. Children: Not recommended.
phentermine HCl	—	CIV	15mg, 30mg	powder-filled or pellet-filled caps	>16yrs: Individualize. Usual dose: 15–30mg at approx. 2hrs after breakfast. Severe renal impairment (eGFR 15–29mL/min/1.73m²): max 15mg daily. ≤16yrs: Not recommended.
	Adipex-P		37.5mg	caps, scored tabs	>16yrs: Individualize. Usual dose: 37.5mg once daily before or 1–2hrs after breakfast, or 18.75mg 1–2 times daily. Avoid late evening dosing. Severe renal impairment (eGFR 15–29mL/min/1.73m²): max 15mg daily. ≤16yrs: Not recommended.
	Lomaira		8mg	scored tabs	>16yrs: Individualize. Use lowest effective dose. Usual dose: 1 tab 3 times daily at approx. 30mins before meals. Avoid late PM dose. ≤16yrs: Not recommended.
SYMPATHOMIMETIC + ANTIEPILEPTIC
phentermine HCl/ topiramate extended-release	Qsymia	CIV	3.75mg/ 23mg, 7.5mg/ 46mg, 11.25mg/ 69mg, 15mg/ 92mg	caps	Take once daily in AM. ≥12yrs: Initially 3.75mg/23mg for 14 days; then increase to 7.5mg/46mg and evaluate weight loss after 12wks on this dose. If failed to lose ≥3% baseline body wt. or BMI, increase to 11.25mg/69mg for 14 days; followed by an increase to 15mg/92mg and evaluate weight loss after 12wks on this dose. If failed to lose ≥5% baseline body wt. or BMI, discontinue by taking 15mg/92mg every other day for at least 1 week prior to stopping altogether. Consider dose reduction if weight loss exceeds 2lbs (0.9kg) per week. Renal (moderate or severe), hepatic (moderate) impairment: max 7.5mg/46mg once daily. <12yrs: Not established.
NOTES
* A dual agonist of the GLP-1 and GIP (glucose-dependent insulinotropic polypeptides) receptors. ^† For obesity due to proopiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) deficiency confirmed by genetic testing; or Bardet-Biedl syndrome (BBS). Not an inclusive list of medications or dosing details. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 3/2024)

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