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What do you Know about Weight Loss Medications?
Alex Evans, PharmD, MBA
Weight loss is essential to arrest the cardiovascular disease and metabolic dysfunction linked to obesity. What do you know about the drugs now available that may help?
With overweight and obesity reaching epidemic levels in the United States and the strong association between excess adiposity and cardiovascular disease, weight loss is recommended by professional societies as part of a heart health plan for at-risk patients. Weight-loss drugs are a valuable part of that plan when used appropriately. How much do you know about dosage, interactions, and safety warnings? Take this quiz and find out!
Answer: D. 16 weeks. Saxenda should be discontinued at 16 weeks if the patient has not lost at least 4% of their body weight. Like other GLP-1RAs, nausea is the most frequently reported side effect and, in most cases, passes with time.
Answser: A. Lorcaserin increased the risk of cancer. When lorcaserin was approved (June 2012), the FDA required the drug manufacturer to conduct a trial to evaluate the risk of CV problems. That trial included 12,000 patients followed for >5 years and found an increased risk of cancer in the lorcaserin arm. Cancers identified included pancreatic, colon, and lung.
FDA asked the manufacturer to voluntarily remove the drug from the market, according to a 2/13/20 FDA Drug Safety Communication.
Answer: C. Qsymia is associated with an increased risk of birth defects. Qsymia is associated with an increased risk of orofacial clefts, especially when taken in the first trimester. It must be discontinued immediatelyif pregnancy occurs. Women of reproductive potential should be counseled to use effective contraceptionwhile on Qsymia.
Providers must complete the Qsymia REMS training program to prescribe Qsymia.
4. Which of the above are points for counseling patients newly prescribed naltrexone/bupropion (Contrave )?
Answer: A and C are counseling points for patients new to Contrave. Contrave should not be taken with high-fat meals; doing so will significantly increase the patient’s exposure to both naltrexone and bupropion (option A). Nausea and constipation are common and usually transient side effects of the drug (option C).
Other points to know about Contrave. Because of the naltrexone component, discontinue Contrave before starting opioids and counsel the patient on the interaction. Because of the bupropion component, do not use in patients with seizures. Maximum dose is 1 tablet by mouth twice daily when taken with CYP2B6 inhibitors. Two good ones to know: ticlopidine (Brilinta) and clopidogrel (Plavix).
5. With which of the medications above does orlistat (Xenical) interact? (more than one option may be correct)
Answer: A (cyclosporine) & B (amiodarone) Orlistat might reduce plasma concentrations of cyclosporine and amiodarone. Other interactions to watch out for:
•Warfarin
•Antiepileptics
•HIV therapy
•Levothyroxine