8 FDA-Approved Drugs for Weight Management

For people with obesity, weight loss is often a difficult journey that requires lifestyle changes. Sometimes, when dietary changes and exercise are not enough, your healthcare provider may prescribe a weight loss medication.

Your provider may recommend one of these medications if you:

• Have a body mass index (BMI) of at least 30
• Have a BMI of 27 with an additional medical condition such as high blood pressure, type 2 diabetes, or high cholesterol

This article will discuss eight current Food and Drug Administration (FDA)–approved weight loss drugs on the market.

Xenical (Orlistat)

Xenical (orlistat) can help you lose weight and keep it off. It belongs to a class of medications called lipase inhibitors.

Orlistat reduces the amount of fat absorbed in the gut after eating. When taking it, no more than 30% of your calories should come from fat. Because of how it works, orlistat is often a better choice for people who tend to eat fatty foods.

Dosing for Xenical is usually 120 milligrams (mg) three times daily. It comes as capsules that should be taken with food or up to one hour after a meal.

Orlistat can reduce the absorption of fat-soluble vitamins in the body; therefore, it's recommended to take a daily multivitamin at bedtime.

How Effective Is It?

Clinical trials have suggested that orlistat provides modest weight loss in people with obesity.

The XENDOS study evaluated orlistat's ability to prevent diabetes in individuals with obesity over four years. Over the course of the study, orlistat users lost, on average, about 13 pounds compared to 7 pounds in the placebo group. Orlistat also lowered the risk of developing type 2 diabetes.

If orlistat works for you, you might expect to lose at least 5% of your body weight in one year.

Orlistat has also been shown to reduce BMI, waist circumference, cholesterol, and low-density lipoprotein (LDL) levels (considered "bad" cholesterol).

However, it may not be as effective as other weight-loss medications. In another study, people who took the drug liraglutide (sold under the brand names Saxenda and Victoza) lost more weight (about 17 pounds) than those on orlistat (about 7 pounds) over seven months.

Other Considerations

You should not take Xenical if:

• You are pregnant.
• You have malabsorption syndrome.
• You have cholestasis (the slowing or stalling of bile flow through your biliary system).
• You have a known hypersensitivity to orlistat.

Additionally, certain medications can interact with Xenical, such as:

• Cyclosporine
• Levothyroxine
• Anticoagulants, including Jantoven (warfarin)
• Amiodarone
• Antiepileptic medications
• Antiretrovirals, such as Norvir (ritonavir)

While taking Xenical, you may experience these side effects:

• Fatty stools
• Gas with oily spotting
• Increased stools that are more difficult to control
• Increased defecation

Taking a fiber-containing supplement, like psyllium, along with Xenical can reduce some of the gastrointestinal (GI)–related side effects.

Alli (Orlistat)

Like Xenical, Alli contains the active ingredient orlistat. This version is available over the counter (OTC) and comes in a 60 mg capsule.

Alli works the same way as Xenical, by reducing the amount of fat absorbed in your gut. It is only for adults 18 or older.

Because Alli has the same active ingredient as Xenical, it has similar side effects and safety considerations to account for. However, Alli tends to be better tolerated than Xenical because it is a lower dose.

How Effective Is It?

In clinical studies, most people who took the 60 mg version of orlistat lost 5 to 10 pounds over six months.

Orlistat 60 mg has been shown to have 85% of the efficacy of the 120 mg orlistat dose.

Contrave (Bupropion-Naltrexone)

Contrave is a combination medication that consists of bupropion, an antidepressant, and naltrexone, an opioid antagonist. The two work together to help you lose weight along with a low-calorie diet and appropriate exercise.

Contrave is usually taken differently every week for the first month. Follow the dosing schedule prescribed by your healthcare provider. Do not take it with high-fat meals.

How Effective Is It? 

In four clinical trials, people who were overweight or with obesity took Contrave for up to 56 weeks.

Overall, people who took Contrave lost more body weight than those who took a placebo. For example, in one study, 40% of participants who took Contrave lost at least 5% of their body weight, and 20% of participants lost at least 10%.

The average weight loss across all four studies ranged from 11 to 22 pounds for those taking the medication.

Contrave also helped lower hemoglobin A1c in people with type 2 diabetes.

Other Considerations

Do not use Contrave if you:

• Are pregnant 
• Have uncontrolled high blood pressure
• Have a seizure disorder
• Are diagnosed with anorexia or bulimia 
• Have recently abruptly stopped drinking alcohol, benzodiazepines, barbiturates, or antiepileptic medications
• Are using another medication that contains bupropion 
• Use opioids chronically 
• Have taken a monoamine oxidase inhibitor (MAOI) within the last two weeks
• Have an allergy to any of the ingredients found in Contrave 

While taking Contrave, the following side effects are possible:

• Nausea or vomiting
• Constipation
• Headache
• Dizziness
• Trouble sleeping
• Dry mouth
• Mental changes
• Increased blood pressure and heart rate
• Low blood sugar

Saxenda (Liraglutide)

Saxenda (liraglutide) belongs to a class of medications known as glucagon-like-peptide receptor agonists (GLP-1), which work by stimulating the GLP-1 receptor in the brain. This can help to regulate appetite.

Saxenda is a medication injected subcutaneously (under the skin).

You'll usually take your dose once daily, with or without meals. When first starting treatment, your healthcare provider will have you start at a lower dose and then gradually increase it over the coming weeks.

Saxenda is also one of the obesity treatments that can be used in children ages 12 to 17 with obesity. Talk to your child’s healthcare provider about dosing, as it can vary for children. 

How Effective Is It?

A large trial evaluated liraglutide in individuals who were overweight or had obesity. The participants had diabetes or prediabetes. By the end of the study (56 weeks), Saxenda users reported statistically significant weight loss compared with those who took the placebo.

In this study, 63% of the participants who took Saxenda lost at least 5% of their body weight. About 33% lost at least 10% of their body weight.

In another study of people without diabetes, Saxenda was more effective for weight loss than lifestyle interventions alone. It also showed sustained weight loss over two years.

Other Considerations

When taking Saxenda, common side effects can include:

• Nausea or vomiting 
• Constipation or diarrhea
• Low blood sugar 
• Indigestion
• Gastroenteritis 

Do not start Saxenda if you:

• Have had a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
• Are pregnant 
• Have an allergy or sensitivity to any of the ingredients in Saxenda 

When starting Saxenda, talk to your healthcare provider if you develop abdominal pain, nausea, or vomiting that does not go away.

Qsymia (Phentermine-Topiramate)

Qsymia is combination medication made up of phentermine, a medication similar to amphetamines, and topiramate, an anti-seizure medication. It works in the brain to reduce your appetite.

Usually, Qsymia is taken once daily in the morning because it can cause insomnia.

Children 12 years and older can take Qysmia if they have a BMI considered to be in the 95th percentile. Talk to your healthcare provider about your child’s BMI to determine if Qsymia is right for them. 

How Effective Is It?

At the maximum dose in initial clinical studies, 70% of adult participants who took Qysmia lost at least 5% of their body weight in one year. Almost half lost 10% or more of their body weight.

In additional studies, Qysmia resulted in an average weight loss of about 17 pounds compared with a placebo. The amount of weight lost was dependent on the dose.

Other Considerations

For adults, common side effects can include:

• Changes in taste
• Tingling or numbness on the skin
• Insomnia 
• Constipation 
• Dry mouth 

For children, common side effects can include:

• Depression
• Dizziness
• Muscle aches and pains 
• Fever 

Do not start Qsymia if you:

• Are pregnant or thinking of becoming pregnant, or are breastfeeding
• Have glaucoma
• Have hyperthyroidism
• Have an allergy or sensitivity to any of the ingredients in Qsymia 
• Are currently taking an MAOI or have taken one within two weeks

When starting Qsymia, watch for any changes in your mood. Talk to your healthcare provider about monitoring your kidney function, heart rate, and sodium and potassium levels. If your child takes Qsymia, monitor for signs of stunted growth. 

Certain medications can interact with Qsymia. These include:

• Birth control pills
• Sedatives, opioids, or hypnotics 
• Alcohol

Imcivree (Setmelanotide)

Imcivree belongs to a class of medications called melanocortin receptor agonists, which can affect fat formation in the body. 

Imcivree is injected under the skin. It helps control your hunger and appetite if you have certain genetic dispositions that include:

• Bardet-Biedl syndrome
• Gene deficiencies such as pro-opiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor deficiency (LEPR)

If prescribed Imcivree, your dose may depend on your kidney health. It's important to rotate the area where you inject Imcivree to prevent injection site reactions or scarring on the skin. 

How Effective Is It?

Two clinical trials studied how well Imicvree works in people with obesity due to gene deficiencies of POMC, PCSK1, or LEPR.

In these studies, 80% of people with POMC or PCSK1 deficiencies achieved at least 10% weight loss after one year. Forty percent of those with LEPR deficiency had a 10% weight loss in one year.

Other Considerations

The most common side effects seen with Imcivree are:

• Changes in skin color 
• Injection site reactions 
• Nausea or vomiting 
• Headache 
• Diarrhea
• Depression 

Imcivree should not be used in infants or newborns as an ingredient found in Imcivree can be fatal to this population.

When taking Imcivree, watch for any changes in sexual function. For males, contact your healthcare provider if you develop an erection lasting longer than four hours. Watch for any changes in your mood.

Wegovy (Semaglutide)

Like Saxenda, Wegovy is a GLP-1 receptor agonist. It stimulates the GLP-1 receptor in the brain, making you feel full.

Wegovy may be prescribed to children 12 and older with a BMI in the 95th percentile (considered obese). 

Wegovy is given under the skin once weekly, at the same time every week, with or without meals. 

How Effective Is It?

In studies, semaglutide was more effective at reducing body weight and HbA1c than placebo. When used in addition to lifestyle interventions, 2.4 mg of semaglutide once weekly resulted in an average weight loss of 15%.

More people who took semaglutide (86%) lost at least 5% of their body weight compared with those on placebo (13%). About seventy percent of users lost at least 10% of their body weight.

Studies have also shown semaglutide to be superior to some other weight-loss agents. Compared with liraglutide, more semaglutide users achieved weight loss greater than 5% or 10%.

Other Considerations

Common side effects seen with Wegovy may include: 

• Nausea or vomiting
• Diarrhea or constipation 
• Abdominal pain
• Headache 
• Tiredness 

Let your healthcare provider know if you are taking any other medications, as Wegovy can affect their concentrations in the body. 

Do not start Wegovy if you:

• Have had a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2
• Are pregnant, or if you are planning on becoming pregnant. Wegovy should be stopped at least 2 months before trying to conceive in both males and females
• Have an allergy or sensitivity to any of the ingredients in Wegovy  

Zepbound (tirzepatide)

Zepbound is a dual-acting glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. Zepbound activates these hormones, making you feel full.

Zepbound is a medication injected subcutaneously and is approved for adults with obesity.

The recommended maintenance dosage of Zepbound is 5-15 mg, injected once weekly.

How Effective Is It?

Two large trials evaluated Zepbound in individuals who were overweight or obese. By the end of the study (72 weeks), people who dieted, exercised and took Zepbound reported statistically significant weight loss compared to those who took the placebo.

Other Considerations

Common side effects seen with Zepbound may include:

• Nausea or vomiting
• Diarrhea or constipation
• Abdominal pain
• Tiredness
  

Summary

Medications like the ones mentioned above may be beneficial when diet and exercise are not enough to reach your weight goal. Your healthcare provider can help you find the best option based on your health goals, medical history, and personal preferences.

However, these medications aren’t quick fixes. Lifestyle changes are strongly recommended in obesity treatment. Continue eating a healthy, well-balanced diet and engaging in a consistent exercise routine, even after achieving weight loss goals.